MEDICARE: RAMTIN SHIRAZIMOHAMMADI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	113231	CA

General Provider Information

NPI Number	:	1891487781
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAMTIN SHIRAZIMOHAMMADI

Provider Business Mailing Address
First Line	:	25476 MOSSWOOD WAY
Second Line	:
City	:	LAKE FOREST
State	:	CA
Zip	:	92630-7401
Country	:	US
Telephone Number	:	310-948-9147
Fax Number	:

Provider Business Practice Location Address
First Line	:	460 N MCKINLEY ST
Second Line	:
City	:	CORONA
State	:	CA
Zip	:	92879-3405
Country	:	US
Telephone Number	:	951-577-0102
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2023
Last Update Date	:	06/24/2026

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Directions to “ RAMTIN SHIRAZIMOHAMMADI ” Practice Location

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