=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841027315
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TARANEH ASHARIMIAMI DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/18/2024
-----------------------------------------------------
Last Update Date | 09/18/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5731 E SANTA ANA CANYON RD STE A
-----------------------------------------------------
City | ANAHEIM
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92807-3234
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-998-2956
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5985 AVENIDA ANTIGUA
-----------------------------------------------------
City | YORBA LINDA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92887-3512
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-765-6987
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 110799
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------