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General NPI Number Information
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NPI Number | 1104181916
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Entity Type | Individual
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Provider Name | MOHAMMAD NIKAHD
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Gender | Male
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Dates
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Enumeration Date | 07/08/2012
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Last Update Date | 02/06/2020
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Provider Practice Location Address
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Address Line | 720 MAGNOLIA AVE STE C1
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City | CORONA
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State | CA
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Zip | 92879-3119
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Country | US
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Telephone | 951-737-1092
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Fax |
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Provider Business Mailing Address
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Address Line | 22691 FOXRIDGE
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City | MISSION VIEJO
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State | CA
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Zip | 92692-4730
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Country | US
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Telephone | 832-605-3938
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 28136
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 100044
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License Number State | CA
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