Healthcare Provider Details

I. General information

NPI: 1679019806
Provider Name (Legal Business Name): SHARIF ELBAYOUMY, DDS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2017
Last Update Date: 01/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26302 LA PAZ RD SUITE 212
MISSION VIEJO CA
92691-5313
US

IV. Provider business mailing address

26302 LA PAZ RD SUITE 212
MISSION VIEJO CA
92691
US

V. Phone/Fax

Practice location:
  • Phone: 714-832-9151
  • Fax:
Mailing address:
  • Phone: 714-832-9151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number50907
License Number StateCA

VIII. Authorized Official

Name: DR. SHARIF ELBAYOUMY
Title or Position: OWNER
Credential: DDS, MS
Phone: 714-832-9151