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General NPI Number Information
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NPI Number | 1609316439
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Entity Type | Organization
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Legal Business Name | AFSHIN DOOSTAN DDS INC
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Dates
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Enumeration Date | 02/27/2017
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Last Update Date | 11/04/2022
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Provider Practice Location Address
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Address Line | 14017 VAN NESS AVE
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City | GARDENA
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State | CA
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Zip | 90249-2915
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Country | US
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Telephone | 310-327-8612
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Fax | 310-327-5177
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Provider Business Mailing Address
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Address Line | 14017 VAN NESS AVE
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City | GARDENA
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State | CA
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Zip | 90249-2915
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Country | US
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Telephone | 310-327-8612
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Fax | 310-327-5177
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Authorized Official
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Title or Position | OWNER/ DOCTOR
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Name | DR. AFSHIN DOOSTAN
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Credential | D.D.S.
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Telephone | 310-327-8612
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 46051
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License Number State | CA
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