Provider Demographics
NPI:1508624834
Name:AMIN, PRIYAL RONAK
Entity Type:Individual
Prefix:
First Name:PRIYAL
Middle Name:RONAK
Last Name:AMIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 LEUCADIA
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92602-2414
Mailing Address - Country:US
Mailing Address - Phone:913-808-8617
Mailing Address - Fax:
Practice Address - Street 1:38 LEUCADIA
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92602-2414
Practice Address - Country:US
Practice Address - Phone:913-808-8617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA109937122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist