Healthcare Provider Details

I. General information

NPI: 1962319616
Provider Name (Legal Business Name): POUR MONAJEM ZADEH DENTAL MISSION VIEJO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24896 CHRISANTA DR STE 110
MISSION VIEJO CA
92691-4800
US

IV. Provider business mailing address

24896 CHRISANTA DR STE 110
MISSION VIEJO CA
92691-4800
US

V. Phone/Fax

Practice location:
  • Phone: 949-461-0000
  • Fax: 949-461-0030
Mailing address:
  • Phone: 213-357-6807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. SEPIDEH POUR MONAJEM ZADEH
Title or Position: PRESIDENT
Credential: DDS
Phone: 213-357-6807