Healthcare Provider Details

I. General information

NPI: 1164359113
Provider Name (Legal Business Name): SOUTH COAST DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 JOURNEY STE 250
ALISO VIEJO CA
92656-5344
US

IV. Provider business mailing address

5 JOURNEY STE 250
ALISO VIEJO CA
92656-5344
US

V. Phone/Fax

Practice location:
  • Phone: 949-360-1021
  • Fax: 949-360-4125
Mailing address:
  • Phone: 949-360-1021
  • Fax: 949-360-4125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: POURIA MALEKI
Title or Position: CEO
Credential: DDS
Phone: 949-360-1021