Healthcare Provider Details

I. General information

NPI: 1487088415
Provider Name (Legal Business Name): NARJES AHMADI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2013
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17991 EUCLID ST
FOUNTAIN VALLEY CA
92708-5409
US

IV. Provider business mailing address

59 FEATHER RDG
MISSION VIEJO CA
92692-5185
US

V. Phone/Fax

Practice location:
  • Phone: 714-378-0085
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number15435
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberD100112
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number0401414160
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: