Healthcare Provider Details

I. General information

NPI: 1174396188
Provider Name (Legal Business Name): AMIR KAMALI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2023
Last Update Date: 11/01/2023
Certification Date: 11/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1206 E 17TH ST
SANTA ANA CA
92701-2641
US

IV. Provider business mailing address

410 ALMOND RD
SAN MARCOS CA
92078-7337
US

V. Phone/Fax

Practice location:
  • Phone: 714-352-2911
  • Fax:
Mailing address:
  • Phone: 469-442-9020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number109580
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: