Provider Demographics
NPI:1952524357
Name:HEDAYATI, SHAHRAZAR (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHAHRAZAR
Middle Name:
Last Name:HEDAYATI
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 1:12445 HILLTOP DR
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:94024-5220
Mailing Address - Country:US
Mailing Address - Phone:650-949-3525
Mailing Address - Fax:650-949-5008
Practice Address - Street 1:693 E REMINGTON DR
Practice Address - Street 2:SUITE C
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-1941
Practice Address - Country:US
Practice Address - Phone:408-738-1113
Practice Address - Fax:408-738-1175
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA312811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice