Healthcare Provider Details

I. General information

NPI: 1780506014
Provider Name (Legal Business Name): DARIUS MODARRES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

24835 LA PALMA AVE STE F
YORBA LINDA CA
92887-5532
US

IV. Provider business mailing address

27030 DAISY CIR
YORBA LINDA CA
92887-4233
US

V. Phone/Fax

Practice location:
  • Phone: 714-319-4579
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number113457
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: