Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 50927 | CA |
Y | 1223D0004X | Dentist Anesthesiologist | 50927 | CA |
NPI | 1548323397 |
---|---|
Provider Name | Dr. Marjon Bekhrad Jahromi |
First Address | Irvine, CA 92602-2400 |
Second Address | Santa Ana, CA 92704-4339 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2006 |
Last Update Date | 16/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1273 | GA PERMIT (01) | CA |
50927 | DENTAL LICENSE (01) | CA |