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General NPI Number Information
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NPI Number | 1629627716
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Entity Type | Individual
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Provider Name | MOHAMMAD MEHDI IMANI EMADI DDS, MS
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Gender | Male
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Dates
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Enumeration Date | 09/10/2019
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Last Update Date | 12/13/2024
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Provider Practice Location Address
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Address Line | 3918 LONG BEACH BLVD STE 200
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City | LONG BEACH
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State | CA
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Zip | 90807-2685
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Country | US
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Telephone | 562-242-2075
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Fax |
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Provider Business Mailing Address
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Address Line | 3918 LONG BEACH BLVD STE 200
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City | LONG BEACH
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State | CA
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Zip | 90807-2685
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Country | US
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Telephone | 562-242-2075
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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 | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 35710
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 108351
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License Number State | CA
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