Healthcare Provider Details

I. General information

NPI: 1861938268
Provider Name (Legal Business Name): ZINABADI DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2017
Last Update Date: 01/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23823 EL TORO RD E122
LAKE FOREST CA
92630-4743
US

IV. Provider business mailing address

23823 EL TORO RD E122
LAKE FOREST CA
92630-4743
US

V. Phone/Fax

Practice location:
  • Phone: 949-855-9212
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number60659
License Number StateCA

VIII. Authorized Official

Name: DR. ALVAND ZINABADI
Title or Position: PRESIDENT
Credential:
Phone: 818-312-1892