Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 52426 | CA |
NPI | 1013177625 |
---|---|
Provider Name | Dr. Saeid Malboubi |
First Address | Irvine, CA 92620-3656 |
Second Address | Irvine, CA 92620-3656 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2008 |
Last Update Date | 01/06/2011 |