Healthcare Provider Details

I. General information

NPI: 1154680296
Provider Name (Legal Business Name): AFSHIN BADII D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2012
Last Update Date: 06/20/2025
Certification Date: 06/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11980 SAN VICENTE BLVD STE 900
LOS ANGELES CA
90049-6607
US

IV. Provider business mailing address

11980 SAN VICENTE BLVD STE 900
LOS ANGELES CA
90049-6607
US

V. Phone/Fax

Practice location:
  • Phone: 310-979-2160
  • Fax: 310-979-2161
Mailing address:
  • Phone: 310-979-2160
  • Fax: 310-979-2161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number65249
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: