1912901893 NPI number — BAHAR GHAFOURI D.D.S., M.S., A.P.C.

Table of content: BAHAR GHAFOURI D.D.S., M.S., A.P.C. (NPI 1912901893)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912901893 NPI number — BAHAR GHAFOURI D.D.S., M.S., A.P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GHAFOURI
Provider First Name:
BAHAR
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.D.S., M.S., A.P.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912901893
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/15/2006
NPI Reactivation Date:
03/29/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 OSBORN ST
Provider Second Line Business Mailing Address:
STE 180
Provider Business Mailing Address City Name:
IRVINE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92604-4690
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-786-7800
Provider Business Mailing Address Fax Number:
949-786-3881

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 OSBORN ST
Provider Second Line Business Practice Location Address:
STE 180
Provider Business Practice Location Address City Name:
IRVINE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92604-4690
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-786-7800
Provider Business Practice Location Address Fax Number:
949-786-3881
Provider Enumeration Date:
06/09/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223X0400X , with the licence number:  41080 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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