Healthcare Provider Details

I. General information

NPI: 1023931680
Provider Name (Legal Business Name): JAWAD ABOU NASSAR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23024 LAKE FOREST DR STE A
LAGUNA HILLS CA
92653-1328
US

IV. Provider business mailing address

1910 S UNION ST UNIT 5022
ANAHEIM CA
92805-7421
US

V. Phone/Fax

Practice location:
  • Phone: 949-716-7166
  • Fax:
Mailing address:
  • Phone: 213-440-5222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number113679
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: