Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 15302 | MD |
N | 122300000X | Dentist | 15302 | VA |
Y | 122300000X | Dentist | 60385 | CA |
NPI | 1003243049 |
---|---|
Provider Name | Alireza Khoshvaghti |
First Address | San Francisco, CA 94104-3410 |
Second Address | San Francisco, CA 94104-3410 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2013 |
Last Update Date | 20/04/2020 |