Healthcare Provider Details

I. General information

NPI: 1396936993
Provider Name (Legal Business Name): FARSHID BORNA DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2007
Last Update Date: 08/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 CENTURY PARK E STE 405
LOS ANGELES CA
90067-2007
US

IV. Provider business mailing address

2080 CENTURY PARK E STE 405
LOS ANGELES CA
90067-2007
US

V. Phone/Fax

Practice location:
  • Phone: 310-553-1583
  • Fax: 310-553-6718
Mailing address:
  • Phone: 310-553-1583
  • Fax: 310-553-6718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number46028
License Number StateCA

VIII. Authorized Official

Name: DR. FARSHID BORNA
Title or Position: PRESIDENT
Credential: DDS, MS
Phone: 310-553-1583