Provider Demographics
NPI:1841491172
Name:HAMSAYEH, NILOUFER GOSHTASB (DDS)
Entity type:Individual
Prefix:
First Name:NILOUFER
Middle Name:GOSHTASB
Last Name:HAMSAYEH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 SUTTER ST # ST615
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-1107
Mailing Address - Country:US
Mailing Address - Phone:415-362-5315
Mailing Address - Fax:
Practice Address - Street 1:229 MARTINIQUE AVE
Practice Address - Street 2:
Practice Address - City:TIBURON
Practice Address - State:CA
Practice Address - Zip Code:94920-1044
Practice Address - Country:US
Practice Address - Phone:415-435-2312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42052122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist