Provider Demographics
NPI:1508011768
Name:MALAKOOTI, HOSSEIN (DDS)
Entity Type:Individual
Prefix:
First Name:HOSSEIN
Middle Name:
Last Name:MALAKOOTI
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 1:38 STREAMWOOD
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-1937
Mailing Address - Country:US
Mailing Address - Phone:949-929-5634
Mailing Address - Fax:714-389-6997
Practice Address - Street 1:530 S. MAIN ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868
Practice Address - Country:US
Practice Address - Phone:949-929-5634
Practice Address - Fax:714-389-6997
Is Sole Proprietor?:No
Enumeration Date:2008-12-01
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56972122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist