Provider Demographics
NPI:1730373531
Name:HAJIHOSSEIN, FATEMEH (DDS)
Entity type:Individual
Prefix:
First Name:FATEMEH
Middle Name:
Last Name:HAJIHOSSEIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9812 WEXFORD CIR
Mailing Address - Street 2:
Mailing Address - City:GRANITE BAY
Mailing Address - State:CA
Mailing Address - Zip Code:95746-7117
Mailing Address - Country:US
Mailing Address - Phone:916-791-5161
Mailing Address - Fax:
Practice Address - Street 1:9812 WEXFORD CIR
Practice Address - Street 2:
Practice Address - City:GRANITE BAY
Practice Address - State:CA
Practice Address - Zip Code:95746-7117
Practice Address - Country:US
Practice Address - Phone:916-791-5161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-05
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54848122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist