Provider Demographics
NPI:1013309368
Name:KARIMI, KOOHYAR (DDS)
Entity Type:Individual
Prefix:DR
First Name:KOOHYAR
Middle Name:
Last Name:KARIMI
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 1:24942 SILVERLEAF LN
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-4917
Mailing Address - Country:US
Mailing Address - Phone:949-903-6080
Mailing Address - Fax:
Practice Address - Street 1:3500 S BRISTOL ST
Practice Address - Street 2:ST 100
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-7319
Practice Address - Country:US
Practice Address - Phone:714-957-6030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-24
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA643351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice