1033376587 NPI number — MALEK K. MANSOUR, ANWAAR R. MANSOUR AND YAHYA M. MANSOUR D.D.S., INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033376587 NPI number — MALEK K. MANSOUR, ANWAAR R. MANSOUR AND YAHYA M. MANSOUR D.D.S., INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MALEK K. MANSOUR, ANWAAR R. MANSOUR AND YAHYA M. MANSOUR D.D.S., 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:
Provider Other Organization Name Type Code:
6
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:
1033376587
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/13/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22 ODYSSEY
Provider Second Line Business Mailing Address:
265
Provider Business Mailing Address City Name:
IRVINE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92618-7701
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-585-1515
Provider Business Mailing Address Fax Number:
949-585-1519

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22 ODYSSEY
Provider Second Line Business Practice Location Address:
265
Provider Business Practice Location Address City Name:
IRVINE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92618-7701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-585-1515
Provider Business Practice Location Address Fax Number:
949-585-1519
Provider Enumeration Date:
05/21/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MANSOUR
Authorized Official First Name:
MALEK
Authorized Official Middle Name:
KAMAL
Authorized Official Title or Position:
DENTIST
Authorized Official Telephone Number:
949-585-1515

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  29971 , 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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