Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 20916 | FL |
Y | 122300000X | Dentist | 64391 | CA |
NPI | 1003212333 |
---|---|
Provider Name | Ramin Khoshsar |
First Address | Irvine, CA 92614-0229 |
Second Address | Lake Forest, CA 92630-8358 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2014 |
Last Update Date | 04/08/2016 |