Ali Heidari, D.D.S.
Dentist in San Jose, CA. Individual provider (NPI-1).
NPI number1063563765
StatusActive
Last updated in NPPESJul 8, 2007
Details
- NPI
- 1063563765
- Entity type
- Individual (NPI-1)
- Name
- Mr. Ali Heidari
- Credential
- D.D.S.
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Jan 16, 2007
- Last updated
- Jul 8, 2007
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 122300000X | Dentist | 46264 | CA | Yes |
Practice location
100 O'Connor DriveSuite # 33
San Jose, CA 95128-1647
Phone 408-287-5704 · Fax 408-287-0415
Mailing address
100 Oconnor DrSuite # 33
San Jose, CA 95128-1647
Phone 408-287-5704 · Fax 408-287-0415
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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