Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 106542 | CA |
N | 1223D0001X | Dental Public Health | 106542 | CA |
N | 1223G0001X | General Practice | 106542 | CA |
N | 213EG0000X | General Practice | 106542 | CA |
NPI | 1720650575 |
---|---|
Provider Name | Mahsa Ighani |
First Address | Los Angeles, CA 90015-3394 |
Second Address | Los Angeles, CA 90015-3394 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2021 |
Last Update Date | 12/07/2021 |