Provider Demographics
NPI:1891207155
Name:HOOMAN FAKHRAI DMD, INC
Entity Type:Organization
Organization Name:HOOMAN FAKHRAI DMD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HOOMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FAKHRAI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:619-656-9222
Mailing Address - Street 1:3252 VIA ALICANTE
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-2742
Mailing Address - Country:US
Mailing Address - Phone:858-336-1442
Mailing Address - Fax:
Practice Address - Street 1:754 MEDICAL CENTER CT STE 201
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-6656
Practice Address - Country:US
Practice Address - Phone:619-656-9222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-26
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty