Provider Demographics
NPI:1609529445
Name:POURIA MALEKI DDS II INC
Entity Type:Organization
Organization Name:POURIA MALEKI DDS II INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:POURIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MALEKI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-401-3047
Mailing Address - Street 1:2940 W LINCOLN AVE STE L&K
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-6294
Mailing Address - Country:US
Mailing Address - Phone:714-995-4000
Mailing Address - Fax:
Practice Address - Street 1:2940 W LINCOLN AVE STE L&K
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-6294
Practice Address - Country:US
Practice Address - Phone:714-995-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-01
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA54940OtherDENTIST