Provider Demographics
NPI:1831280288
Name:MASSOUDI, KATAYOUN (DDS)
Entity Type:Individual
Prefix:
First Name:KATAYOUN
Middle Name:
Last Name:MASSOUDI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30092 SANTA MARGARITA PARKWAY
Mailing Address - Street 2:STE K
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688
Mailing Address - Country:US
Mailing Address - Phone:949-888-0086
Mailing Address - Fax:949-888-0095
Practice Address - Street 1:30092 SANTA MARGARITA PARKWAY
Practice Address - Street 2:STE K
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688
Practice Address - Country:US
Practice Address - Phone:949-888-0086
Practice Address - Fax:949-888-0095
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB41644122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist