MEDICARE: NEGAR DERAKHSHANI

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	46045	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1689886814	OTHER	CA	STATE

General Provider Information

NPI Number	:	1801262290
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NEGAR DERAKHSHANI

Provider Business Mailing Address
First Line	:	6082 EDINGER AVE
Second Line	:	SUITE B
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-3264
Country	:	US
Telephone Number	:	714-846-2827
Fax Number	:	714-846-4311

Provider Business Practice Location Address
First Line	:	6082 EDINGER AVE
Second Line	:	SUITE B
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-3264
Country	:	US
Telephone Number	:	714-846-2827
Fax Number	:	714-846-4311

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

Provider Enumeration Date	:	08/19/2015
Last Update Date	:	08/19/2015

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Directions to “ NEGAR DERAKHSHANI ” Practice Location

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