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General NPI Number Information
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NPI Number | 1972013134
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Entity Type | Organization
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Legal Business Name | MASSOUD KASHANCHI, DDS. PROF. CORP.
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Dates
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Enumeration Date | 10/02/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1503 S COAST DR
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City | COSTA MESA
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State | CA
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Zip | 92626-1534
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Country | US
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Telephone | 714-662-4424
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Fax |
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Provider Business Mailing Address
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Address Line | 1503 S. COAST DR. 110
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City | COSTA MESA
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State | CA
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Zip | 92626
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Country | US
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Telephone | 714-662-4424
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. MASSOUD KASHANCHI
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Credential | DDS.
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Telephone | 714-662-4424
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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 | 30399
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License Number State | CA
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