=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750050795
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JAVID OSAFI DMD INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/13/2021
-----------------------------------------------------
Last Update Date | 09/13/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4980 BARRANCA PKWY STE 206
-----------------------------------------------------
City | IRVINE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92604-8655
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-612-0687
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4980 BARRANCA PKWY STE 206
-----------------------------------------------------
City | IRVINE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92604-8655
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-612-0687
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER / DENTIST
-----------------------------------------------------
Name | DR. JAVID FARAN OSAFI
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 702-612-0687
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------