Provider Demographics
NPI:1972816619
Name:LIDA AHMADI-KASHANI D.M.D.,INC.
Entity Type:Organization
Organization Name:LIDA AHMADI-KASHANI D.M.D.,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMADI-KASHANI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:949-830-9671
Mailing Address - Street 1:23521 PASEO DE VALENCIA STE 208
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-3140
Mailing Address - Country:US
Mailing Address - Phone:949-830-9671
Mailing Address - Fax:
Practice Address - Street 1:23521 PASEO DE VALENCIA STE 208
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3140
Practice Address - Country:US
Practice Address - Phone:949-830-9671
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-23
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49440122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty