Healthcare Provider Details

I. General information

NPI: 1679478630
Provider Name (Legal Business Name): MICHAEL AMIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2026
Last Update Date: 10/10/2026
Certification Date: 10/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3013 COCHRAN ST STE D
SIMI VALLEY CA
93065-2771
US

IV. Provider business mailing address

369 S DOHENY DR APT 326
BEVERLY HILLS CA
90211-3508
US

V. Phone/Fax

Practice location:
  • Phone: 805-522-2600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number113885
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: