| Katayoun Omrani, Dds A Professional Dental Corporation | |
|
444 S San Vicente Blvd Ste 1101 Los Angeles CA 90048-4170 | |
| (310) 423-9600 | |
| (310) 423-9610 |
| Full Name | Katayoun Omrani, Dds A Professional Dental Corporation |
|---|---|
| Speciality | Dentist |
| Location | 444 S San Vicente Blvd Ste 1101, Los Angeles, California |
| Authorized Official Name and Position | Katayoun Omrani (PRESIDENT/AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 3106668189 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Katayoun Omrani, Dds A Professional Dental Corporation Po Box 60790 Pasadena CA 91116-6790 Ph: (626) 795-6596 | Katayoun Omrani, Dds A Professional Dental Corporation 444 S San Vicente Blvd Ste 1101 Los Angeles CA 90048-4170 Ph: (310) 423-9600 |
| NPI Number | 1396136974 |
|---|---|
| Provider Enumeration Date | 02/18/2015 |
| Last Update Date | 02/18/2015 |
| Medicare PECOS PAC ID | 5496061053 |
|---|---|
| Medicare Enrollment ID | O20150827003292 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396136974 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 45399 (California) | Primary |
| Provider Name | Katayoun Omrani |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1386967875 PECOS PAC ID: 7416137526 Enrollment ID: I20110207000847 |
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