Provider Demographics
NPI:1003212333
Name:KHOSHSAR, RAMIN (DMD)
Entity Type:Individual
Prefix:
First Name:RAMIN
Middle Name:
Last Name:KHOSHSAR
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 APRILLA
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-0229
Mailing Address - Country:US
Mailing Address - Phone:949-748-6301
Mailing Address - Fax:
Practice Address - Street 1:26501 RANCHO PKWY S
Practice Address - Street 2:SUITE 202
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-8358
Practice Address - Country:US
Practice Address - Phone:949-273-8220
Practice Address - Fax:949-273-8120
Is Sole Proprietor?:No
Enumeration Date:2014-11-13
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20916122300000X
CA64391122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist