Healthcare Provider Details

I. General information

NPI: 1336153287
Provider Name (Legal Business Name): JAFAR ASSAF DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12791 NEWPORT AVENUE #100 100
TUSTIN CA
92780
US

IV. Provider business mailing address

12791 NEWPORT AVENUE #100 100
TUSTIN CA
92780
US

V. Phone/Fax

Practice location:
  • Phone: 714-832-8000
  • Fax: 714-832-8007
Mailing address:
  • Phone: 714-832-8000
  • Fax: 626-335-7911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number24708
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: