Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 10109 | KY |
N | 1223S0112X | Oral and Maxillofacial Surgeon | 33196 | TX |
NPI | 1114449584 |
---|---|
Provider Name | Seyedeh Fereshte Valaei |
First Address | Lexington, KY 40536-0293 |
Second Address | Lexington, KY 40536 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2017 |
Last Update Date | 03/06/2018 |