| Afshin Doostan, D.d.s., Inc. | |
|
14017 Van Ness Ave Gardena CA 90249-2915 | |
| (310) 327-8612 | |
| (310) 327-5177 |
| Full Name | Afshin Doostan, D.d.s., Inc. |
|---|---|
| Speciality | Dentist |
| Location | 14017 Van Ness Ave, Gardena, California |
| Authorized Official Name and Position | Afshin Doostan (OWNER/ DOCTOR) |
| Authorized Official Contact | 3103278612 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Afshin Doostan, D.d.s., Inc. 14017 Van Ness Ave Gardena CA 90249-2915 Ph: (310) 327-8612 | Afshin Doostan, D.d.s., Inc. 14017 Van Ness Ave Gardena CA 90249-2915 Ph: (310) 327-8612 |
| NPI Number | 1609316439 |
|---|---|
| Provider Enumeration Date | 02/27/2017 |
| Last Update Date | 11/04/2022 |
| Medicare PECOS PAC ID | 7113238486 |
|---|---|
| Medicare Enrollment ID | O20150624000544 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609316439 | NPI | - | NPPES |
| G89838 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 46051 (California) | Primary |
| Provider Name | Afshin Doostan |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1659466456 PECOS PAC ID: 8022329390 Enrollment ID: I20150613000086 |
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