Healthcare Provider Details

I. General information

NPI: 1134417603
Provider Name (Legal Business Name): BADII LEE DENTAL CORPORATION, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2011
Last Update Date: 04/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14370 CULVER DR STE A
IRVINE CA
92604-0319
US

IV. Provider business mailing address

14370 CULVER DR STE A
IRVINE CA
92604-0319
US

V. Phone/Fax

Practice location:
  • Phone: 949-551-6555
  • Fax: 949-551-6556
Mailing address:
  • Phone: 949-551-6555
  • Fax: 949-551-6556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number54538
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: KIAVASH KEVIN BADII
Title or Position: PRESIDENT
Credential: DDS
Phone: 714-835-2383