# JALAL FATEHI

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1619193521
- **Gender:** Man
- **Credential:** DDS

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 204E00000X | Oral & Maxillofacial Surgery (D.M.D.) | 046724 | NY | Yes |
| 204E00000X | Oral & Maxillofacial Surgery (D.M.D.) | 22DI01985000 | NJ | — |

## Other

- **Enumeration date:** 04/18/2007
- **Last updated:** 10/10/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 01683834 | — | NY |
| 05 | — | 0457841 | — | NJ |