Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 65280 | CA |
NPI | 1104245976 |
---|---|
Provider Name | Dr. Omid Niavarani |
First Address | Huntington Beach, CA 92647-7518 |
Second Address | Huntington Beach, CA 92647-7518 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2014 |
Last Update Date | 24/09/2019 |