Healthcare Provider Details

I. General information

NPI: 1225189715
Provider Name (Legal Business Name): MEHRBANOU ZOMORRODI D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2007
Last Update Date: 12/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 DECENTE
IRVINE CA
92614-7306
US

IV. Provider business mailing address

4 DECENTE
IRVINE CA
92614-7306
US

V. Phone/Fax

Practice location:
  • Phone: 949-474-7274
  • Fax:
Mailing address:
  • Phone: 949-474-7274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number41052
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: