1023122330 NPI number — JAHANGIRI DDS INC.

Table of content: (NPI 1023122330)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023122330 NPI number — JAHANGIRI DDS INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JAHANGIRI DDS INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SOUTHERN CALIFORNIA FAMILY DENTISTRY
Provider Other Organization Name Type Code:
3
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:
1023122330
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/18/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14412 WHITTIER BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHITTIER
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90605-2105
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
562-693-0788
Provider Business Mailing Address Fax Number:
562-693-6813

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14412 WHITTIER BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHITTIER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90605-2105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-693-0788
Provider Business Practice Location Address Fax Number:
562-693-6813
Provider Enumeration Date:
08/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JAHANGIRI
Authorized Official First Name:
HOSSEIN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER DENTIST
Authorized Official Telephone Number:
562-693-0788

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  43611 , 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)

  • Identifier: 0024396 . This is a "AETNA DMO" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 5332 . This is a "PACIFIC UNION DENTAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 7032 . This is a "PACIFICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 971074 . This is a "UNITED CONCORDIA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 002501 . This is a "DELTA DENTAL PMI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 100450 . This is a "DENTAL HEALTH SERVICES" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 239078 . This is a "CIGNA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: B43611 . This is a "DENTICAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 55292 . This is a "SAFE GUARD HEALTHY FAM." identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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