Healthcare Provider Details

I. General information

NPI: 1477475291
Provider Name (Legal Business Name): HYKAL KHOSRAVIBABADI DENTAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 E ALOSTA AVE STE 108
AZUSA CA
91702-2710
US

IV. Provider business mailing address

680 E ALOSTA AVE STE 108
AZUSA CA
91702-2710
US

V. Phone/Fax

Practice location:
  • Phone: 81-869-9388
  • Fax:
Mailing address:
  • Phone: 81-869-9388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. HYKAL KHOSRAVIBABADI
Title or Position: CEO
Credential:
Phone: 81-869-9388