Provider Demographics
NPI:1598430019
Name:SAGE, BINA, KOROURI DENTAL OFFICE OF LA TIJERA, INC.
Entity Type:Organization
Organization Name:SAGE, BINA, KOROURI DENTAL OFFICE OF LA TIJERA, INC.
Other - Org Name:PHD DENTAL OF WESTCHESTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:AMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:KOROURI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-927-5848
Mailing Address - Street 1:3000 WHITTIER BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90023-1637
Mailing Address - Country:US
Mailing Address - Phone:232-695-4373
Mailing Address - Fax:
Practice Address - Street 1:6907 LA TIJERA BLVD STE A
Practice Address - Street 2:
Practice Address - City:WESTCHESTER
Practice Address - State:CA
Practice Address - Zip Code:90045-1906
Practice Address - Country:US
Practice Address - Phone:310-645-0336
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-16
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty