Provider Demographics
NPI:1912634460
Name:KANDAR, MOHAMMAD AGHIAD (DDS)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD AGHIAD
Middle Name:
Last Name:KANDAR
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 1:498 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94111-1617
Mailing Address - Country:US
Mailing Address - Phone:415-397-2804
Mailing Address - Fax:415-397-2804
Practice Address - Street 1:498 JACKSON ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94111-1617
Practice Address - Country:US
Practice Address - Phone:415-397-2804
Practice Address - Fax:415-397-2804
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-04
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1077081223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA107708OtherDENTAL BOARD OF CALIFORNIA