Basic Information
| Provider Information | |||||||||
| NPI: | 1598899767 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOSLEMI | ||||||||
| FirstName: | AFSANEH | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2909 NIEMAN BLVD | ||||||||
| Address2: | APT #122 | ||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951484228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4082937000 | ||||||||
| FaxNumber: | 7145713560 | ||||||||
| Practice Location | |||||||||
| Address1: | 48 E SANTA CLARA ST | ||||||||
| Address2: | |||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951131805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4082937000 | ||||||||
| FaxNumber: | 4082781187 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2007 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 49151 | CA | Y | Dental Providers | Dentist |
ID Information
| ID | Type | State | Issuer | Description | D49151 | 05 | CA | MEDICAID |