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General NPI Number Information
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NPI Number | 1649615030
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Entity Type | Individual
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Provider Name | ATOUSA FARAHANI D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 04/30/2013
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 3580 GRAND AVE STE K
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City | CHINO HILLS
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State | CA
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Zip | 91709-5401
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Country | US
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Telephone | 909-548-6900
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Fax |
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Provider Business Mailing Address
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Address Line | 3 RAVENSRIDGE
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City | TRABUCO CANYON
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State | CA
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Zip | 92679-3812
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Country | US
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Telephone | 949-306-7677
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 057199-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 64942
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License Number State | CA
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