1225428717 NPI number — BADII LEE DENTAL CORPORATION, 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 1225428717 NPI number — BADII LEE DENTAL CORPORATION, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BADII LEE DENTAL CORPORATION, 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:
1225428717
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/04/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1920 MAIN ST STE 970
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IRVINE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92614-8275
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-596-8100
Provider Business Mailing Address Fax Number:
562-424-9807

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1001 W CARSON ST STE H
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TORRANCE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90502-2051
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-618-1522
Provider Business Practice Location Address Fax Number:
562-618-9272
Provider Enumeration Date:
02/04/2015

Additional Information

Authorized Official

Authorized Official Last Name:
BADII
Authorized Official First Name:
KIAVASH
Authorized Official Middle Name:
KEVIN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
949-596-8100

Provider Taxonomy Codes

  • Taxonomy code: 1223X0400X , 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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