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General NPI Number Information
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NPI Number | 1225575566
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Entity Type | Organization
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Legal Business Name | BABAK YOUSEFI DENTAL CORPORATION
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Dates
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Enumeration Date | 01/25/2017
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Last Update Date | 01/25/2017
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Provider Practice Location Address
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Address Line | 4134 WOODRUFF AVE
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City | LAKEWOOD
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State | CA
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Zip | 90713-3141
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Country | US
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Telephone | 562-420-4400
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Fax | 562-420-1114
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Provider Business Mailing Address
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Address Line | 12265 LA MIRADA BLVD
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City | LA MIRADA
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State | CA
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Zip | 90638-1329
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Country | US
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Telephone | 562-944-8408
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BABAK YOUSEFI
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Credential |
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Telephone | 562-420-4400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 49464
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 49464
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License Number State | CA
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