Individual
KEIVAN ZOUFAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS, MDS
Contact information
Practice address
10055 MILLER AVE, SUITE 103, CUPERTINO, CA 95014-3472
(310) 592-0731
Mailing address
10055 MILLER AVE, SUITE 103, CUPERTINO, CA 95014-3472
(310) 592-0731
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
009797
CT
1223E0200X
Endodontics
Primary
52700
CA
1223G0001X
General Practice Dentistry
000032
NY
1223G0001X
General Practice Dentistry
009797
CT
1223G0001X
General Practice Dentistry
6120
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02701531
—
NY
01
—
9181534
DORAL
NY
Enumeration date
07/28/2006
Last updated
03/04/2013
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