Healthcare Provider Details

I. General information

NPI: 1366634339
Provider Name (Legal Business Name): DR. KAMBIZ AMINI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2007
Last Update Date: 02/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1706 TREASURE HILLS BLVD
HARLINGEN TX
78550-8911
US

IV. Provider business mailing address

1515 PAPPAS ST
LAREDO TX
78041-1705
US

V. Phone/Fax

Practice location:
  • Phone: 956-365-6003
  • Fax:
Mailing address:
  • Phone: 956-523-3642
  • Fax: 956-718-6294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0025990
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: