MEDICARE: AFSHIN DOOSTAN,DDS,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	122300000X	Dentist	46051	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184815979
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AFSHIN DOOSTAN,DDS,INC.

Provider Business Mailing Address
First Line	:	6330 VAN NUYS BLVD
Second Line	:	B
City	:	VAN NUYS
State	:	CA
Zip	:	91401-2610
Country	:	US
Telephone Number	:	818-785-9944
Fax Number	:	818-785-9922

Provider Business Practice Location Address
First Line	:	6330 VAN NUYS BLVD
Second Line	:	B
City	:	VAN NUYS
State	:	CA
Zip	:	91401-2610
Country	:	US
Telephone Number	:	818-785-9944
Fax Number	:	818-785-9922

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. AFSHIN DOOSTAN
Credential	:	D.D.S.
Telephone Number	:	818-785-9944

Provider Enumeration Date	:	08/06/2007
Last Update Date	:	08/06/2007

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