Provider Demographics
NPI:1225575566
Name:BABAK YOUSEFI DENTAL CORPORATION
Entity Type:Organization
Organization Name:BABAK YOUSEFI DENTAL CORPORATION
Other - Org Name:CHILDREN'S HAPPY TEETH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BABAK
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUSEFI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-420-4400
Mailing Address - Street 1:12265 LA MIRADA BLVD
Mailing Address - Street 2:
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-1329
Mailing Address - Country:US
Mailing Address - Phone:562-944-8408
Mailing Address - Fax:
Practice Address - Street 1:4134 WOODRUFF AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90713-3141
Practice Address - Country:US
Practice Address - Phone:562-420-4400
Practice Address - Fax:562-420-1114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-25
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA494641223P0221X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty