Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 54600 | CA |
NPI | 1447316864 |
---|---|
Provider Name | Dr. Babak Heidari |
First Address | Orange, CA 92867-5903 |
Second Address | Orange, CA 92867-5903 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2006 |
Last Update Date | 14/05/2011 |