Healthcare Provider Details

I. General information

NPI: 1073206215
Provider Name (Legal Business Name): MAHER RIFAI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2023
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date: 07/21/2026
Reactivation Date: 07/31/2026

III. Provider practice location address

5720 IMPERIAL HWY STE N-O
SOUTH GATE CA
90280-7518
US

IV. Provider business mailing address

11612 CULVER BLVD APT 309
LOS ANGELES CA
90066-3859
US

V. Phone/Fax

Practice location:
  • Phone: 323-776-1500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number113273
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: