Provider Demographics
NPI:1568110070
Name:BINA, KOROURI, SAGE DENTAL CORPORATION
Entity Type:Organization
Organization Name:BINA, KOROURI, SAGE DENTAL CORPORATION
Other - Org Name:PHD DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PEDRAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BINA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-433-2722
Mailing Address - Street 1:12052 IMPERIAL HWY STE 101A
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-3090
Mailing Address - Country:US
Mailing Address - Phone:562-307-9200
Mailing Address - Fax:
Practice Address - Street 1:12052 IMPERIAL HWY STE 101A
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-3090
Practice Address - Country:US
Practice Address - Phone:562-307-9200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-14
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty