Healthcare Provider Details

I. General information

NPI: 1467062224
Provider Name (Legal Business Name): MAHIN G FARZIN, DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2020
Last Update Date: 08/06/2020
Certification Date: 08/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 NEWPORT CENTER DR STE 3
NEWPORT BEACH CA
92660-7507
US

IV. Provider business mailing address

220 NEWPORT CENTER DR STE 3
NEWPORT BEACH CA
92660-7507
US

V. Phone/Fax

Practice location:
  • Phone: 949-759-9777
  • Fax:
Mailing address:
  • Phone: 949-759-9777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MAHIN FARZIN
Title or Position: OWNER
Credential: DDS
Phone: 949-759-9777