Amir Mohammad Chalak, D.D.S., M.D.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

61292 Issued in CA

Practice address

1580 Winchester Blvd Ste 101
Campbell, CA 95008-0519

Phone

(408) 379-5360

NPI assigned

Jul 3, 2012

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1341273600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1512432000000",
    "number": "1134483258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 CHINA BASIN ST APT 223",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941582363",
            "telephone_number": "650-302-7909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1580 WINCHESTER BLVD STE 101",
            "city": "CAMPBELL",
            "state": "CA",
            "postal_code": "950080519",
            "telephone_number": "408-379-5360"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHALAK",
        "first_name": "AMIR",
        "middle_name": "MOHAMMAD",
        "name_prefix": "Dr.",
        "credential": "D.D.S., M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-07-03",
        "last_updated": "2017-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "61292",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CA",
            "license": "61292",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sara Patricia Cerrillo, ASW
• Lelani Certeza
• Julia Angelica Cervantes-Gonzalez
• Kyndra Cervantes, D.C.
• Ruth Cervantes, FNP
• Lori Chambers, LCSW
• Teagan Chambers
• Baldwin Chan
• Jemimah Chan, RD
• Kim Chan

• Oral and Maxillofacial Surgery (Dentist) in Campbell, CA
• Providers in Campbell, CA by specialty
• Oral and Maxillofacial Surgery (Dentist) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.