Healthcare Provider Details

I. General information

NPI: 1609939628
Provider Name (Legal Business Name): LILY GHAFOURI D.M.D., M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9201 W SUNSET BLVD SUITE 200
LOS ANGELES CA
90069-3701
US

IV. Provider business mailing address

9919 ANTHONY PL
BEVERLY HILLS CA
90210-2001
US

V. Phone/Fax

Practice location:
  • Phone: 310-273-5775
  • Fax:
Mailing address:
  • Phone: 310-858-1374
  • Fax: 310-858-6776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number53064
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: