Healthcare Provider Details

I. General information

NPI: 1114537602
Provider Name (Legal Business Name): AKBAR KHORSHIDI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2020
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 441
BURBANK CA
91503-0441
US

IV. Provider business mailing address

PO BOX 564
SAN MARCOS CA
92079-0564
US

V. Phone/Fax

Practice location:
  • Phone: 760-666-5066
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberD012627
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number39200
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number39200
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number105153
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: