Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 000203543 | CO |
N | 204E00000X | Oral & Maxillofacial Surgeon | 101382 | CA |
NPI | 1275831208 |
---|---|
Provider Name | Dr. Kamran Dastoury |
First Address | Lancaster, CA 93535-4124 |
Second Address | Lakewood, CO 80215-1546 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2011 |
Last Update Date | 05/05/2018 |