Provider Demographics
NPI:1801984547
Name:ZOURBAKHSH, REZA (DDS)
Entity type:Individual
Prefix:DR
First Name:REZA
Middle Name:
Last Name:ZOURBAKHSH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5710 CAHALAN AVE
Mailing Address - Street 2:#4
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123
Mailing Address - Country:US
Mailing Address - Phone:408-972-2100
Mailing Address - Fax:408-281-2320
Practice Address - Street 1:5710 CAHALAN AVE
Practice Address - Street 2:#4
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123
Practice Address - Country:US
Practice Address - Phone:408-972-2100
Practice Address - Fax:408-281-2320
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA422591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice