Provider Demographics
NPI:1578146833
Name:TEHRANI, MAHSA
Entity Type:Individual
Prefix:DR
First Name:MAHSA
Middle Name:
Last Name:TEHRANI
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 1:16420 FITZPATRICK CT UNIT 258
Mailing Address - Street 2:
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-6406
Mailing Address - Country:US
Mailing Address - Phone:562-237-2367
Mailing Address - Fax:
Practice Address - Street 1:16420 FITZPATRICK CT UNIT 258
Practice Address - Street 2:
Practice Address - City:LA MIRADA
Practice Address - State:CA
Practice Address - Zip Code:90638-6406
Practice Address - Country:US
Practice Address - Phone:562-237-2367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-04
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1056691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice