Provider Demographics
NPI:1417244039
Name:AMINI, FARHAD (DDS)
Entity Type:Individual
Prefix:DR
First Name:FARHAD
Middle Name:
Last Name:AMINI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:259 E WORKMAN ST
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-3507
Mailing Address - Country:US
Mailing Address - Phone:714-395-3009
Mailing Address - Fax:
Practice Address - Street 1:259 E WORKMAN ST
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-3507
Practice Address - Country:US
Practice Address - Phone:714-282-9966
Practice Address - Fax:714-282-9969
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-03
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901020414122300000X
CA621721223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentist