Provider Demographics
NPI:1982073565
Name:FARHAD KIANI DDS A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:FARHAD KIANI DDS A PROFESSIONAL CORPORATION
Other - Org Name:DENTIST IN GREEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FARHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:KIANI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-777-6688
Mailing Address - Street 1:22611 LAKE FOREST DR
Mailing Address - Street 2:SUITE C-5
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-1700
Mailing Address - Country:US
Mailing Address - Phone:949-777-6688
Mailing Address - Fax:
Practice Address - Street 1:22611 LAKE FOREST DR
Practice Address - Street 2:SUITE C-5
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-1700
Practice Address - Country:US
Practice Address - Phone:949-777-6688
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-24
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59172122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty