MEDICARE: H. POURSHIRAZI DMD, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	44064	CA

General Provider Information

NPI Number	:	1003957457
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	H. POURSHIRAZI DMD, INC

Provider Business Mailing Address
First Line	:	27851 BRADLEY RD
Second Line	:	#155
City	:	SUN CITY
State	:	CA
Zip	:	92586-2286
Country	:	US
Telephone Number	:	951-672-9457
Fax Number	:	951-672-7878

Provider Business Practice Location Address
First Line	:	27851 BRADLEY RD STE 155
Second Line	:
City	:	SUN CITY
State	:	CA
Zip	:	92586-2244
Country	:	US
Telephone Number	:	951-672-9457
Fax Number	:	951-672-7878

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. HOMAYOUN POURSHIRAZI
Credential	:
Telephone Number	:	951-672-9457

Provider Enumeration Date	:	02/09/2007
Last Update Date	:	07/02/2009

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