Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 52875 | CA |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 52875 | CA |
NPI | 1053417261 |
---|---|
Provider Name | Dr. Ardavan R. Kheradpir |
First Address | Fresno, CA 93720-8006 |
Second Address | Fresno, CA 93726-4301 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2006 |
Last Update Date | 04/08/2016 |