Provider Demographics
NPI:1609316439
Name:AFSHIN DOOSTAN DDS INC
Entity Type:Organization
Organization Name:AFSHIN DOOSTAN DDS INC
Other - Org Name:AFSHIN DOOSTAN, D.D.S., INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AFSHIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DOOSTAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-327-8612
Mailing Address - Street 1:14017 VAN NESS AVE
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90249-2915
Mailing Address - Country:US
Mailing Address - Phone:310-327-8612
Mailing Address - Fax:310-327-5177
Practice Address - Street 1:14017 VAN NESS AVE
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90249-2915
Practice Address - Country:US
Practice Address - Phone:310-327-8612
Practice Address - Fax:310-327-5177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-27
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA460511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG89838Medicaid