Basic Information
| Provider Information | |||||||||
| NPI: | 1396136974 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | KATAYOUN OMRANI, DDS A PROFESSIONAL DENTAL CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 60790 | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911166790 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6267956596 | ||||||||
| FaxNumber: | 6263960851 | ||||||||
| Practice Location | |||||||||
| Address1: | 444 S SAN VICENTE BLVD STE 1101 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900484170 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3104239600 | ||||||||
| FaxNumber: | 3104239610 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/18/2015 | ||||||||
| LastUpdateDate: | 02/18/2015 | ||||||||
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| AuthorizedOfficialLastName: | OMRANI | ||||||||
| AuthorizedOfficialFirstName: | KATAYOUN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT/AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 3106668189 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DDS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 45399 | CA | Y | 193200000X MULTI-SPECIALTY GROUP | Dental Providers | Dentist |
No ID Information.