Provider Demographics
NPI:1265001945
Name:KARIMI, AMIRALI
Entity Type:Individual
Prefix:
First Name:AMIRALI
Middle Name:
Last Name:KARIMI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 MAREBLU STE 360
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-3056
Mailing Address - Country:US
Mailing Address - Phone:949-360-9700
Mailing Address - Fax:
Practice Address - Street 1:15 MAREBLU STE 360
Practice Address - Street 2:
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-3056
Practice Address - Country:US
Practice Address - Phone:949-360-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-17
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1062501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice