Provider Demographics
NPI:1265058176
Name:NASRIN KHAJEH DMD, INC.
Entity type:Organization
Organization Name:NASRIN KHAJEH DMD, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NASRIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAJEH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:714-508-8080
Mailing Address - Street 1:2530 BRYAN AVE STE E
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92782-8916
Mailing Address - Country:US
Mailing Address - Phone:714-508-8080
Mailing Address - Fax:714-508-8080
Practice Address - Street 1:2530 BRYAN AVE STE E
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92782-8916
Practice Address - Country:US
Practice Address - Phone:714-508-8080
Practice Address - Fax:714-508-8080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-17
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty