Healthcare Provider Details

I. General information

NPI: 1497171953
Provider Name (Legal Business Name): ALI KARIMI DDS MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2014
Last Update Date: 03/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 WATERWORKS WAY STE 355
IRVINE CA
92618-3172
US

IV. Provider business mailing address

113 WATERWORKS WAY STE 355
IRVINE CA
92618-3172
US

V. Phone/Fax

Practice location:
  • Phone: 949-527-6449
  • Fax:
Mailing address:
  • Phone: 949-527-6449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number57537
License Number StateCA

VIII. Authorized Official

Name: MAHYAR KARIMI
Title or Position: PRESIDENT
Credential: DDS
Phone: 949-527-6449