MEDICARE: ATOUSA FARAHANI 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	1223P0221X	Pediatric Dentistry	057199-1	NY
2	1223P0221X	Pediatric Dentistry	64942	CA

General Provider Information

NPI Number	:	1649615030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ATOUSA FARAHANI D.D.S.

Provider Business Mailing Address
First Line	:	3 RAVENSRIDGE
Second Line	:
City	:	TRABUCO CANYON
State	:	CA
Zip	:	92679-3812
Country	:	US
Telephone Number	:	949-306-7677
Fax Number	:

Provider Business Practice Location Address
First Line	:	3580 GRAND AVE STE K
Second Line	:
City	:	CHINO HILLS
State	:	CA
Zip	:	91709-5401
Country	:	US
Telephone Number	:	909-548-6900
Fax Number	:

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

Provider Enumeration Date	:	04/30/2013
Last Update Date	:	07/21/2022

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