Provider Demographics
NPI:1134307143
Name:MASOUMI, KIAN (RDHAP)
Entity Type:Individual
Prefix:MRS
First Name:KIAN
Middle Name:
Last Name:MASOUMI
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28002 MILT CIR
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-3779
Mailing Address - Country:US
Mailing Address - Phone:949-350-5426
Mailing Address - Fax:949-360-6106
Practice Address - Street 1:28002 MILT CIR
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-3779
Practice Address - Country:US
Practice Address - Phone:949-350-5426
Practice Address - Fax:949-360-6106
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-01
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA201124Q00000X
CA17035171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
No171100000XOther Service ProvidersAcupuncturist