MEDICARE: DR. KATHY MAASOUMI D.D.S.

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	41949	CA

General Provider Information

NPI Number	:	1407998941
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHY MAASOUMI D.D.S.

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	:	949-307-6437
Fax Number	:

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	:	949-307-6437
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	11/14/2014

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