Provider Demographics
NPI:1861806507
Name:TAGHIKHAN, SHAHIN (DDS)
Entity type:Individual
Prefix:DR
First Name:SHAHIN
Middle Name:
Last Name:TAGHIKHAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 BLOSSOM HILL RD STE 102
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-5403
Mailing Address - Country:US
Mailing Address - Phone:084-225-5000
Mailing Address - Fax:
Practice Address - Street 1:704 BLOSSOM HILL RD STE 102
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-5403
Practice Address - Country:US
Practice Address - Phone:408-225-5000
Practice Address - Fax:408-225-5020
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-19
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012923A1223S0112X
CA640751223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery