Provider Demographics
NPI:1023568581
Name:FARHAD AMINI DENTAL CORPORATION
Entity Type:Organization
Organization Name:FARHAD AMINI DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST /PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FARHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:AMINI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-332-0638
Mailing Address - Street 1:259 E WORKMAN ST
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-3507
Mailing Address - Country:US
Mailing Address - Phone:626-332-0638
Mailing Address - Fax:
Practice Address - Street 1:259 E WORKMAN ST
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-3507
Practice Address - Country:US
Practice Address - Phone:626-332-0638
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-09
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62172261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental