Provider Demographics
NPI:1376707661
Name:SAFAEDDIN JAHANBANI D.D.S., INC.
Entity Type:Organization
Organization Name:SAFAEDDIN JAHANBANI D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAFAEDDIN
Authorized Official - Middle Name:
Authorized Official - Last Name:JAHANBANI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-836-7831
Mailing Address - Street 1:113 WATERWORKS WAY STE 130
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3168
Mailing Address - Country:US
Mailing Address - Phone:949-836-7831
Mailing Address - Fax:
Practice Address - Street 1:113 WATERWORKS WAY STE 130
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3168
Practice Address - Country:US
Practice Address - Phone:949-836-7831
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-15
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45376261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB45376Medicaid