Provider Demographics
NPI:1669978110
Name:MOHSIN MAHMOOD DDS INC
Entity type:Organization
Organization Name:MOHSIN MAHMOOD DDS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHSIN
Authorized Official - Middle Name:RAZA
Authorized Official - Last Name:MAHMOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-588-6004
Mailing Address - Street 1:24902 MOULTON PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:LAGUNA WOODS
Mailing Address - State:CA
Mailing Address - Zip Code:92637-6403
Mailing Address - Country:US
Mailing Address - Phone:949-619-4162
Mailing Address - Fax:
Practice Address - Street 1:24902 MOULTON PKWY STE 200
Practice Address - Street 2:
Practice Address - City:LAGUNA WOODS
Practice Address - State:CA
Practice Address - Zip Code:92637-6403
Practice Address - Country:US
Practice Address - Phone:949-619-4162
Practice Address - Fax:949-619-4162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-03
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52424122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1669978110OtherNPI NUMBER UPDATE
CA1699978999OtherNPI NUMBER UPDATE