MEDICARE: MAHSHID FARHOUMAND DDS INC

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	122300000X	Dentist

General Provider Information

NPI Number	:	1912243098
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAHSHID FARHOUMAND DDS INC

Provider Business Mailing Address
First Line	:	23024 LAKE FOREST DR
Second Line	:	STE A
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-1328
Country	:	US
Telephone Number	:	949-716-7166
Fax Number	:	949-716-9191

Provider Business Practice Location Address
First Line	:	23024 LAKE FOREST DR
Second Line	:	STE A
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-1328
Country	:	US
Telephone Number	:	949-716-7166
Fax Number	:	949-716-9191

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. MAHSHID FARHOUMAND
Credential	:	DDS
Telephone Number	:	949-716-7166

Provider Enumeration Date	:	12/18/2012
Last Update Date	:	12/18/2012

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