Provider Demographics
NPI:1720490121
Name:KOUROSH HARANDI DENTAL PRACTICE
Entity Type:Organization
Organization Name:KOUROSH HARANDI DENTAL PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KOUROSH
Authorized Official - Middle Name:
Authorized Official - Last Name:HARANDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-837-5633
Mailing Address - Street 1:1844 SAN MIGUEL DR
Mailing Address - Street 2:SUITE 309
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-4962
Mailing Address - Country:US
Mailing Address - Phone:925-938-5633
Mailing Address - Fax:
Practice Address - Street 1:1844 SAN MIGUEL DR
Practice Address - Street 2:SUITE 309
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-4962
Practice Address - Country:US
Practice Address - Phone:925-938-5633
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-20
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA528021223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty