Healthcare Provider Details

I. General information

NPI: 1013417443
Provider Name (Legal Business Name): M.G. FARZIN, D.D.S., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2018
Last Update Date: 02/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 EAST FIRST STREET SUITE 230
SANTA ANA CA
92705
US

IV. Provider business mailing address

2010 EAST FIRST STREET SUITE 230
SANTA ANA CA
92705
US

V. Phone/Fax

Practice location:
  • Phone: 714-546-5579
  • Fax: 714-542-2785
Mailing address:
  • Phone: 714-546-5579
  • Fax: 714-542-8785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number52980
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number49050
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number43754
License Number StateCA

VIII. Authorized Official

Name: MAHIN G FARZIN
Title or Position: CEO
Credential: DDS
Phone: 714-546-5579