Provider Demographics
NPI:1457873523
Name:RAHIMI-VIJEH, SAM (DMD)
Entity Type:Individual
Prefix:
First Name:SAM
Middle Name:
Last Name:RAHIMI-VIJEH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:SAM
Other - Middle Name:
Other - Last Name:VIJEH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:706 TAMPICO
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2929
Mailing Address - Country:US
Mailing Address - Phone:925-451-4367
Mailing Address - Fax:
Practice Address - Street 1:1255 WILLOW PASS RD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-5218
Practice Address - Country:US
Practice Address - Phone:925-680-4444
Practice Address - Fax:925-680-4443
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-11
Last Update Date:2018-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1015041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty