Provider Demographics
NPI:1649615030
Name:FARAHANI, ATOUSA (DDS)
Entity type:Individual
Prefix:
First Name:ATOUSA
Middle Name:
Last Name:FARAHANI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 RAVENSRIDGE
Mailing Address - Street 2:
Mailing Address - City:TRABUCO CANYON
Mailing Address - State:CA
Mailing Address - Zip Code:92679-3812
Mailing Address - Country:US
Mailing Address - Phone:949-306-7677
Mailing Address - Fax:
Practice Address - Street 1:3580 GRAND AVE STE K
Practice Address - Street 2:
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-5401
Practice Address - Country:US
Practice Address - Phone:909-548-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY057199-11223P0221X
CA649421223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry