Healthcare Provider Details

I. General information

NPI: 1013066687
Provider Name (Legal Business Name): HOUMAN RAHNAMA DDS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 04/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28940 GOLDEN LANTERN #H
LAGUNA NIGUEL CA
92677-1500
US

IV. Provider business mailing address

28940 GOLDEN LANTERN #H
LAGUNA NIGUEL CA
92677-1500
US

V. Phone/Fax

Practice location:
  • Phone: 949-363-2010
  • Fax:
Mailing address:
  • Phone: 949-363-2010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number40979
License Number StateCA

VIII. Authorized Official

Name: DR. HOUMAN RAHNAMA
Title or Position: PRESIDENT
Credential: DDS
Phone: 949-363-2010