Healthcare Provider Details

I. General information

NPI: 1477691178
Provider Name (Legal Business Name): HUMAIRAH AMIN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 05/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3820 SEPULVEDA BLVD
TORRANCE CA
90505-2408
US

IV. Provider business mailing address

625 N PAULINA AVE
REDONDO BEACH CA
90277-3023
US

V. Phone/Fax

Practice location:
  • Phone: 310-792-5200
  • Fax: 310-792-5201
Mailing address:
  • Phone: 310-937-1793
  • Fax: 323-249-7565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number50369
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: