Provider Demographics
NPI:1255447132
Name:H. JAHANGIRI DENTAL CORPORATION
Entity type:Organization
Organization Name:H. JAHANGIRI DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:HOSSEIN
Authorized Official - Middle Name:
Authorized Official - Last Name:JAHANGIRI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-830-3743
Mailing Address - Street 1:23361 EL TORO RD STE #117
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630
Mailing Address - Country:US
Mailing Address - Phone:949-830-3743
Mailing Address - Fax:949-830-6077
Practice Address - Street 1:23361 EL TORO RD STE 117
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-4810
Practice Address - Country:US
Practice Address - Phone:949-830-3743
Practice Address - Fax:949-830-6077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA436111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA204988678OtherTAX ID #