Provider Demographics
NPI:1770626384
Name:KHENY, KSHAMA (BDS)
Entity type:Individual
Prefix:
First Name:KSHAMA
Middle Name:
Last Name:KHENY
Suffix:
Gender:F
Credentials:BDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2762 VISTA DIABLO CT
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-7033
Mailing Address - Country:US
Mailing Address - Phone:925-895-4660
Mailing Address - Fax:
Practice Address - Street 1:9130 ALCOSTA BLVD STE A
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-3847
Practice Address - Country:US
Practice Address - Phone:925-803-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA458891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice