Provider Demographics
NPI:1649500018
Name:KATI ASGARIFAR DDS, INC
Entity type:Organization
Organization Name:KATI ASGARIFAR DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KATI
Authorized Official - Middle Name:OZRA
Authorized Official - Last Name:ASGARIFAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-991-7752
Mailing Address - Street 1:5931 KANAN RD
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-1688
Mailing Address - Country:US
Mailing Address - Phone:818-991-7522
Mailing Address - Fax:
Practice Address - Street 1:5931 KANAN RD
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-1688
Practice Address - Country:US
Practice Address - Phone:818-991-7522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-07
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA427991223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty