Provider Demographics
NPI:1932314077
Name:ALJANEDI, MOHDSAMEER YI (DDS)
Entity Type:Individual
Prefix:
First Name:MOHDSAMEER
Middle Name:YI
Last Name:ALJANEDI
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 1:13488 MAXELLA AVE APT 209
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-4337
Mailing Address - Country:US
Mailing Address - Phone:310-386-8188
Mailing Address - Fax:310-306-4421
Practice Address - Street 1:18800 MAIN ST STE 110
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-1717
Practice Address - Country:US
Practice Address - Phone:714-842-6151
Practice Address - Fax:714-842-6764
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41577122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist