1962562306 NPI number — DR. MALEK K. MANSOUR D.D.S., M.A.G.D. PHD

Table of content: DR. MALEK K. MANSOUR D.D.S., M.A.G.D. PHD (NPI 1962562306)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962562306 NPI number — DR. MALEK K. MANSOUR D.D.S., M.A.G.D. PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MANSOUR
Provider First Name:
MALEK
Provider Middle Name:
K.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.D.S., M.A.G.D. PHD
Provider Gender Code:
M

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:
1962562306
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/29/2012
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:
SUITE 265
Provider Business Mailing Address City Name:
IRVINE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92618-3186
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-585-1515
Provider Business Mailing Address Fax Number:
949-585-1515

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22 ODYSSEY
Provider Second Line Business Practice Location Address:
SUITE 265
Provider Business Practice Location Address City Name:
IRVINE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92618-3186
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:
949-585-1515
Provider Enumeration Date:
12/08/2006

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: 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)





Copyright © 2007-2025 www.npivalidator.com