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NPI Code Detail

MEDICARE: KATHY MAASOUMI D.D.S INC.

MEDICARE: KATHY MAASOUMI D.D.S 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
1122300000XDentist41949CA

General Provider Information

NPI Number : 1033236484
Entity Type Code : Organization
Provider Name (Legal Business Name) : KATHY MAASOUMI D.D.S INC.
Provider Business Mailing Address
First Line : 22706 ASPAN ST
Second Line : SUITE 602
City : LAKE FOREST
State : CA
Zip : 92630-1603
Country : US
Telephone Number : 949-716-7000
Fax Number : 949-716-0600
Provider Business Practice Location Address
First Line : 22706 ASPAN ST
Second Line : SUITE 602
City : LAKE FOREST
State : CA
Zip : 92630-1603
Country : US
Telephone Number : 949-716-7000
Fax Number : 949-716-0600
Authorized Official
Title or Position : OWNER
Name : DR. KATHY MAASOUMI
Credential : DDS
Telephone Number : 949-716-7000
Provider Enumeration Date : 03/23/2007
Last Update Date : 11/14/2014

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