Healthcare Provider Details

I. General information

NPI: 1205229598
Provider Name (Legal Business Name): KIARASH KARIMI D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2015
Last Update Date: 03/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27462 PORTOLA PKWY STE 205
FOOTHILL RANCH CA
92610-2838
US

IV. Provider business mailing address

3425 MOTOR AVE PH 14
LOS ANGELES CA
90034-4590
US

V. Phone/Fax

Practice location:
  • Phone: 949-450-0076
  • Fax:
Mailing address:
  • Phone: 619-727-7754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number64342
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: