Healthcare Provider Details

I. General information

NPI: 1538607965
Provider Name (Legal Business Name): OMID RABI BARHORDAR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2017
Last Update Date: 02/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8077 FLORENCE AVE STE 107
DOWNEY CA
90240-3981
US

IV. Provider business mailing address

8077 FLORENCE AVE STE 107
DOWNEY CA
90240-3981
US

V. Phone/Fax

Practice location:
  • Phone: 562-928-6900
  • Fax: 562-928-7900
Mailing address:
  • Phone: 562-928-6900
  • Fax: 562-928-7900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number58536
License Number StateCA

VIII. Authorized Official

Name: OMID RABI BARHORDAR
Title or Position: DENTIST
Credential:
Phone: 562-928-6900