Provider Demographics
NPI:1033229828
Name:AMINI, MOHAMMAD JOHN (DDS)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:JOHN
Last Name:AMINI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14130 CULVER DR STE I
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-0335
Mailing Address - Country:US
Mailing Address - Phone:949-333-3333
Mailing Address - Fax:949-726-0790
Practice Address - Street 1:14130 CULVER DR STE I
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604
Practice Address - Country:US
Practice Address - Phone:949-333-3333
Practice Address - Fax:949-726-0790
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA470321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice