Provider Demographics
NPI:1407998941
Name:MAASOUMI, KATHY (DDS)
Entity Type:Individual
Prefix:DR
First Name:KATHY
Middle Name:
Last Name:MAASOUMI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22706 ASPAN ST
Mailing Address - Street 2:SUITE 602
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-1603
Mailing Address - Country:US
Mailing Address - Phone:949-307-6437
Mailing Address - Fax:
Practice Address - Street 1:22706 ASPAN ST
Practice Address - Street 2:SUITE 602
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-1603
Practice Address - Country:US
Practice Address - Phone:949-307-6437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41949122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist