Provider Demographics
NPI:1497171953
Name:ALI KARIMI DDS MEDICAL CORPORATION
Entity Type:Organization
Organization Name:ALI KARIMI DDS MEDICAL CORPORATION
Other - Org Name:SAND CANYON ORAL & MAXILLOFACIAL SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAHYAR
Authorized Official - Middle Name:
Authorized Official - Last Name:KARIMI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-527-6449
Mailing Address - Street 1:113 WATERWORKS WAY STE 355
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3172
Mailing Address - Country:US
Mailing Address - Phone:949-527-6449
Mailing Address - Fax:
Practice Address - Street 1:113 WATERWORKS WAY STE 355
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3172
Practice Address - Country:US
Practice Address - Phone:949-527-6449
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-07
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA575371223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty