Healthcare Provider Details

I. General information

NPI: 1255972717
Provider Name (Legal Business Name): OMID HAMID BARKHORDAR DENTAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2019
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16461 WHITTIER BLVD.
WHITTIER CA
90603
US

IV. Provider business mailing address

16461 WHITTIER BLVD
WHITTIER CA
90603-3045
US

V. Phone/Fax

Practice location:
  • Phone: 562-242-3777
  • Fax:
Mailing address:
  • Phone: 562-242-3777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: HAMID BARKHORDAR
Title or Position: PRESIDENT
Credential: DDS
Phone: 818-674-1060