=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194102863
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SORAYA K. MAHRAN, DDS, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/01/2015
-----------------------------------------------------
Last Update Date | 05/01/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 30001 CROWN VALLEY PKWY STE G
-----------------------------------------------------
City | LAGUNA NIGUEL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92677-1723
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-466-4875
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 30001 CROWN VALLEY PKWY STE G
-----------------------------------------------------
City | LAGUNA NIGUEL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92677-1723
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-466-4875
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MR. VICTOR MAHRAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 310-466-4875
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 60096
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------