Healthcare Provider Details

I. General information

NPI: 1548820632
Provider Name (Legal Business Name): B. YOUSEFI DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2019
Last Update Date: 06/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2124 REDONDO BEACH BLVD
TORRANCE CA
90504-1616
US

IV. Provider business mailing address

4134 WOODRUFF AVE
LAKEWOOD CA
90713-3141
US

V. Phone/Fax

Practice location:
  • Phone: 562-420-4400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: BABAK YOUSEFI
Title or Position: PRESIDENT
Credential:
Phone: 562-420-4400