Ehsan Rezvan, DDS, MS

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

53479 Issued in CA

Practice address

7880 Wren Ave
Building D Suite 144
Gilroy, CA 95020-4943

Phone

(408) 842-9045

Fax

(408) 842-7057

NPI assigned

Nov 3, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1162512000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1902985492",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7880 WREN AVE",
            "address_2": "BUILDING D SUITE 144",
            "city": "GILROY",
            "state": "CA",
            "postal_code": "950204943",
            "telephone_number": "408-842-9045",
            "fax_number": "408-842-7057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7880 WREN AVE",
            "address_2": "BUILDING D SUITE 144",
            "city": "GILROY",
            "state": "CA",
            "postal_code": "950204943",
            "telephone_number": "408-842-9045",
            "fax_number": "408-842-7057"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REZVAN",
        "first_name": "EHSAN",
        "credential": "DDS, MS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-03",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "CA",
            "license": "53479",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Manuel Paul Reyes
• Doug Reynolds
• Maria D Reynoso
• Sandra Reynoso
• Veronica Reynoso
• Rafael Anthony Rialson
• Corinne M Ricci, MA, CCC-SLP/L
• Richard J. Harper, MD, Medical Corporation
• Richard P Carr Physical Therapy Inc (Parkside Physical Therapy)
• Richards Sales Consulting, Inc. (Gilroy Medical Supply)

• Periodontics in Gilroy, CA
• Providers in Gilroy, CA by specialty
• Periodontics in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.