=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831287424
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NOOSHIN MAJD DMD ,MSD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/10/2006
-----------------------------------------------------
Last Update Date | 08/14/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 25500 RANCHONIGUEL RD 160
-----------------------------------------------------
City | LAGUNA NIGUEL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92677
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-831-7790
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 36 VIA RUBINO
-----------------------------------------------------
City | NEWPORT COAST
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92657-1608
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-474-3977
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | 51869
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------