Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223D0001X | Dental Public Health | 12012479A | IN |
Y | 1223D0001X | Dental Public Health | DDS101175 | CA |
NPI | 1295184489 |
---|---|
Provider Name | Samila Charkhezarrin |
First Address | San Ramon, CA 94582-4801 |
Second Address | Concord, CA 94520-2348 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2016 |
Last Update Date | 24/02/2020 |