Provider Demographics
NPI:1558008953
Name:KHAEF PROFESSIONAL DENTAL CORP
Entity Type:Organization
Organization Name:KHAEF PROFESSIONAL DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:RAMTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAEF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-510-0225
Mailing Address - Street 1:4005 CALLE SONORA OESTE UNIT 2B
Mailing Address - Street 2:
Mailing Address - City:LAGUNA WOODS
Mailing Address - State:CA
Mailing Address - Zip Code:92637-3240
Mailing Address - Country:US
Mailing Address - Phone:949-510-0225
Mailing Address - Fax:
Practice Address - Street 1:1125 E 17TH ST STE E227
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-2218
Practice Address - Country:US
Practice Address - Phone:714-705-6852
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-17
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental