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General NPI Number Information
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NPI Number | 1083060214
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Entity Type | Organization
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Legal Business Name | BINA, KOROURI, SAGE DENTAL CORPORATION
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Dates
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Enumeration Date | 05/06/2016
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Last Update Date | 06/09/2023
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Provider Practice Location Address
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Address Line | 8604 WHITTIER BLVD
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City | PICO RIVERA
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State | CA
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Zip | 90660-2655
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Country | US
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Telephone | 323-886-0511
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Fax |
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Provider Business Mailing Address
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Address Line | 3000 WHITTIER BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90023-1637
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Country | US
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Telephone | 562-205-4591
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Fax | 562-205-4594
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Authorized Official
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Title or Position | CEO
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Name | DR. PEDRAM BINA
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Credential | D.D.S
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Telephone | 310-433-2722
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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