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General NPI Number Information
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NPI Number | 1134697683
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Entity Type | Individual
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Provider Name | GHAZAL KERMANI
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Gender | Female
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Dates
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Enumeration Date | 11/02/2018
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Last Update Date | 08/14/2025
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Provider Practice Location Address
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Address Line | 350 NORTH CLARK STREET SUITE 600
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City | CHICAGO
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State | IL
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Zip | 60654
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Country | US
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Telephone | 312-274-4526
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Fax |
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Provider Business Mailing Address
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Address Line | 31 SACRED PATH
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City | IRVINE
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State | CA
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Zip | 92618-8857
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Country | US
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Telephone | 949-701-5320
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 107167
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License Number State | CA
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