Healthcare Provider Details

I. General information

NPI: 1164290045
Provider Name (Legal Business Name): FOUJAN JABBARZADEHKHOEI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2023
Last Update Date: 08/16/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2949 BREA BLVD STE A1
FULLERTON CA
92835-2073
US

IV. Provider business mailing address

2949 BREA BLVD STE A1
FULLERTON CA
92835-2073
US

V. Phone/Fax

Practice location:
  • Phone: 714-671-0300
  • Fax:
Mailing address:
  • Phone: 909-318-3809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number113054
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: