Provider Demographics
NPI:1659466456
Name:DOOSTAN, AFSHIN (DDS)
Entity Type:Individual
Prefix:
First Name:AFSHIN
Middle Name:
Last Name:DOOSTAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6330 VAN NUYS BLVD # B
Mailing Address - Street 2:GOLDEN CARE DENTISTRY
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-2610
Mailing Address - Country:US
Mailing Address - Phone:818-785-9944
Mailing Address - Fax:818-785-9922
Practice Address - Street 1:6330 VAN NUYS BLVD # B
Practice Address - Street 2:GOLDEN CARE DENTISTRY
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-2610
Practice Address - Country:US
Practice Address - Phone:818-785-9944
Practice Address - Fax:818-785-9922
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA460511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB46051-01Medicaid
CA954851912OtherTIN