Provider Demographics
NPI:1083262612
Name:KOROURI SAGE BINA PROFESSIONAL DENTAL INC
Entity Type:Organization
Organization Name:KOROURI SAGE BINA PROFESSIONAL DENTAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:AMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:KOROURI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-927-5848
Mailing Address - Street 1:3000 WHITTIER BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90023-1637
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:609 S LONG BEACH BLVD
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90221-4026
Practice Address - Country:US
Practice Address - Phone:310-876-2534
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-27
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty