Healthcare Provider Details

I. General information

NPI: 1093131807
Provider Name (Legal Business Name): BADII LEE DENTAL CORPORATION, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2014
Last Update Date: 03/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1007 W LA PALMA AVE SUITE 2
ANAHEIM CA
92801-3620
US

IV. Provider business mailing address

1007 W LA PALMA AVE SUITE 2
ANAHEIM CA
92801-3620
US

V. Phone/Fax

Practice location:
  • Phone: 714-635-9390
  • Fax: 714-635-9014
Mailing address:
  • Phone: 714-635-9390
  • Fax: 714-635-9014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. KIAVASH KEVIN BADII
Title or Position: DIRECTOR/OWNER
Credential: DDS
Phone: 714-835-2383