Healthcare Provider Details

I. General information

NPI: 1356442859
Provider Name (Legal Business Name): MALEKSHAH M OSKOUI DMD, CAGS, MSD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 11/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 WILD LILAC
IRVINE CA
92620-2831
US

IV. Provider business mailing address

171 WILD LILAC
IRVINE CA
92620-2831
US

V. Phone/Fax

Practice location:
  • Phone: 949-679-1330
  • Fax:
Mailing address:
  • Phone: 949-929-7424
  • Fax: 949-679-1335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number49173
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: