Provider Demographics
NPI:1780621144
Name:YEBRI, FEREYDOUN MICHAEL (DDS)
Entity type:Individual
Prefix:
First Name:FEREYDOUN
Middle Name:MICHAEL
Last Name:YEBRI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:MICHAEL
Other - Middle Name:F
Other - Last Name:YEBRI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:601 N HILLCREST RD
Mailing Address - Street 2:#1
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210
Mailing Address - Country:US
Mailing Address - Phone:310-428-4053
Mailing Address - Fax:310-276-8667
Practice Address - Street 1:2527 W PICO BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006
Practice Address - Country:US
Practice Address - Phone:213-380-2426
Practice Address - Fax:213-380-2931
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB35570122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB3557002Medicaid