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General NPI Number Information
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NPI Number | 1972728335
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Entity Type | Organization
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Legal Business Name | FRED MONEMPOUR,DDS,PROF CORP.
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Dates
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Enumeration Date | 04/13/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 435 N BEDFORD DR SUITE 416
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City | BEVERLY HILLS
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State | CA
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Zip | 90210-4321
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Country | US
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Telephone | 310-278-5993
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Fax |
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Provider Business Mailing Address
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Address Line | 435 N BEDFORD DR SUITE 416
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City | BEVERLY HILLS
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State | CA
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Zip | 90210-4321
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Country | US
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Telephone | 310-278-5993
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. LYN ROSARIO
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Credential |
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Telephone | 310-278-5993
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 46299
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License Number State | CA
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