Healthcare Provider Details

I. General information

NPI: 1003798398
Provider Name (Legal Business Name): NONAMEGIVEN AYESHA MUBEEN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2025
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21229 HAWTHORNE BLVD STE A
TORRANCE CA
90503-5501
US

IV. Provider business mailing address

941 W CARSON ST APT 306
TORRANCE CA
90502-2042
US

V. Phone/Fax

Practice location:
  • Phone: 877-418-5491
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDDS113262
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: