Healthcare Provider Details

I. General information

NPI: 1013177625
Provider Name (Legal Business Name): SAEID MALBOUBI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2008
Last Update Date: 06/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

464 MONROE
IRVINE CA
92620-3656
US

IV. Provider business mailing address

464 MONROE
IRVINE CA
92620-3656
US

V. Phone/Fax

Practice location:
  • Phone: 949-200-0600
  • Fax:
Mailing address:
  • Phone: 949-200-0600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number52426
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: