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Provider Information for 1750595195

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ELMIRA KHODAPANAH D.D.S

Gender: FEMALE

Individual NPI: 1750595195

Calendar Last Updated: 2009-09-17

Details

Name Value
NPI 1750595195
Enumeration Date 2007-05-09
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 12079 WORLD TRADE DR UNIT 4
SAN DIEGO, CA 92128-4393
United States

Phone: 858-485-8855 | Fax:
View Map External Link
Primary Practice Address 2333 CAMINO DEL RIO S STE 140
SAN DIEGO, CA 92108-3607
United States

Phone: 619-574-1810 | Fax: 619-574-1326
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 1223G0001X - Dentist General Practice CA 43989