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NPI Code Detail

MEDICARE: NASRIN KHORRAM DDS

MEDICARE: NASRIN KHORRAM DDS
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
11223G0001XGeneral Practice Dentistry45475CA

General Provider Information

NPI Number : 1538212790
Entity Type Code : Individual
Provider Name (Legal Business Name) : NASRIN KHORRAM DDS
Provider Business Mailing Address
First Line : 13450 HAWTHORNE BLVD
Second Line :
City : HAWTHORNE
State : CA
Zip : 90250-5806
Country : US
Telephone Number : 310-679-0106
Fax Number : 310-679-6698
Provider Business Practice Location Address
First Line : 13450 HAWTHORNE BLVD
Second Line :
City : HAWTHORNE
State : CA
Zip : 90250-5806
Country : US
Telephone Number : 310-679-0106
Fax Number : 310-679-6698
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/19/2007
Last Update Date : 07/08/2007

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Directions to “ NASRIN KHORRAM DDS” Practice Location

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