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General NPI Number Information
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NPI Number | 1558008953
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Entity Type | Organization
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Legal Business Name | KHAEF PROFESSIONAL DENTAL CORP
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Dates
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Enumeration Date | 05/17/2022
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Last Update Date | 05/17/2022
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Provider Practice Location Address
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Address Line | 1125 E 17TH ST STE E227
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City | SANTA ANA
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State | CA
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Zip | 92701-2218
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Country | US
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Telephone | 714-705-6852
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Fax |
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Provider Business Mailing Address
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Address Line | 4005 CALLE SONORA OESTE UNIT 2B
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City | LAGUNA WOODS
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State | CA
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Zip | 92637-3240
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Country | US
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Telephone | 949-510-0225
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/DENTIST
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Name | RAMTIN KHAEF
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Credential |
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Telephone | 949-510-0225
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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