Provider Demographics
NPI:1093853020
Name:ABDOLHOSSEINI, HOSSEIN (DDS)
Entity Type:Individual
Prefix:
First Name:HOSSEIN
Middle Name:
Last Name:ABDOLHOSSEINI
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 1:5715 LARRY DEAN ST
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92880-3151
Mailing Address - Country:US
Mailing Address - Phone:909-947-3063
Mailing Address - Fax:909-947-3063
Practice Address - Street 1:5771 PINE AVE
Practice Address - Street 2:SUITE S
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709
Practice Address - Country:US
Practice Address - Phone:909-597-2477
Practice Address - Fax:909-597-3772
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA507151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice