Healthcare Provider Details

I. General information

NPI: 1538252358
Provider Name (Legal Business Name): DARSHITA JAYDEEP TALIM D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 01/06/2022
Certification Date: 01/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 MAGNOLIA AVE STE 1J
CORONA CA
92879-3100
US

IV. Provider business mailing address

55 TURNBURY LN
IRVINE CA
92620-0244
US

V. Phone/Fax

Practice location:
  • Phone: 951-736-0603
  • Fax:
Mailing address:
  • Phone: 714-389-3852
  • Fax: 714-389-3852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number51141
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number51141
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: