Provider Demographics
NPI:1184815979
Name:AFSHIN DOOSTAN,DDS,INC.
Entity Type:Organization
Organization Name:AFSHIN DOOSTAN,DDS,INC.
Other - Org Name:GOLDEN CARE DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AFSHIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DOOSTAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-785-9944
Mailing Address - Street 1:6330 VAN NUYS BLVD
Mailing Address - Street 2:B
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-2610
Mailing Address - Country:US
Mailing Address - Phone:818-785-9944
Mailing Address - Fax:818-785-9922
Practice Address - Street 1:6330 VAN NUYS BLVD
Practice Address - Street 2:B
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-2610
Practice Address - Country:US
Practice Address - Phone:818-785-9944
Practice Address - Fax:818-785-9922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46051122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB46051-01Medicaid