Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204E00000X | Oral & Maxillofacial Surgeon | 81 | CA |
Y | 204E00000X | Oral & Maxillofacial Surgeon | A103713 | CA |
NPI | 1346397221 |
---|---|
Provider Name | Dr. Nima Sayed Massoomi |
First Address | Cupertino, CA 95014-3235 |
Second Address | Cupertino, CA 95014-3235 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2007 |
Last Update Date | 05/08/2008 |