Provider Demographics
NPI:1871160978
Name:KHAYATAN, BEHZAD (DMD)
Entity type:Individual
Prefix:DR
First Name:BEHZAD
Middle Name:
Last Name:KHAYATAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3190 OAK RD APT 407
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94597-7762
Mailing Address - Country:US
Mailing Address - Phone:925-775-8866
Mailing Address - Fax:
Practice Address - Street 1:2734 DELTA FAIR BLVD
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-4100
Practice Address - Country:US
Practice Address - Phone:925-778-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1061331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice