Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 62011 | CA |
NPI | 1407114499 |
---|---|
Provider Name | Dr. Niloofar Deyhim |
First Address | San Jose, CA 95117-1569 |
Second Address | Palo Alto, CA 94301-2900 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2012 |
Last Update Date | 10/04/2019 |