Provider Demographics
NPI:1396866000
Name:ROYA MIRKHAN, DMD, MSD, INC.
Entity Type:Organization
Organization Name:ROYA MIRKHAN, DMD, MSD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROYA
Authorized Official - Middle Name:NAZILA
Authorized Official - Last Name:MIRKHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MSD
Authorized Official - Phone:858-337-6264
Mailing Address - Street 1:12395 EL CAMINO REAL
Mailing Address - Street 2:SUITE #314
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-3082
Mailing Address - Country:US
Mailing Address - Phone:858-337-6264
Mailing Address - Fax:858-755-6260
Practice Address - Street 1:12395 EL CAMINO REAL
Practice Address - Street 2:SUITE #314
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-3082
Practice Address - Country:US
Practice Address - Phone:858-337-6264
Practice Address - Fax:858-755-6260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44743261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental