MEDICARE: KOOHYAR KARIMI 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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1760040836
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KOOHYAR KARIMI DDS INC

Provider Business Mailing Address
First Line	:	23785 EL TORO RD STE 422
Second Line	:
City	:	LAKE FOREST
State	:	CA
Zip	:	92630-4762
Country	:	US
Telephone Number	:	949-274-9431
Fax Number	:

Provider Business Practice Location Address
First Line	:	24942 SILVERLEAF LN
Second Line	:
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-4917
Country	:	US
Telephone Number	:	949-274-9431
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KOOHYAR KARIMI
Credential	:	DDS
Telephone Number	:	949-274-9431

Provider Enumeration Date	:	06/03/2019
Last Update Date	:	06/03/2019

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