Hossein K. Ebrahim, D.M.D. Inc,

Primary specialty

DentistTaxonomy code 122300000X

License

36307 Issued in CA

Legal business name

HOSSEIN K. EBRAHIM, D.M.D. INC,

Practice address

32122 Paseo Adelanto
Suite 1B
San Juan Capistrano, CA 92675-3605

Phone

(949) 493-6166

Fax

(949) 493-8910

NPI assigned

May 25, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Hossein Kia Ebrahim, DMD

Title

President/Dentist

Phone

(949) 350-6350

Specialties & licenses 2

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Shokouh Ansari, DMD

  • General Practice Dentistry
  • San Juan Capistrano, CA
  • NPI 1750641726
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1337904000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1337904000000",
    "number": "1124388913",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "32122 PASEO ADELANTO",
            "address_2": "SUITE 1B",
            "city": "SAN JUAN CAPISTRANO",
            "state": "CA",
            "postal_code": "926753605",
            "telephone_number": "949-493-6166",
            "fax_number": "949-493-8910"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "32122 PASEO ADELANTO",
            "address_2": "SUITE 1B",
            "city": "SAN JUAN CAPISTRANO",
            "state": "CA",
            "postal_code": "926753605",
            "telephone_number": "949-493-6166",
            "fax_number": "949-493-8910"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOSSEIN K. EBRAHIM, D.M.D. INC,",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-25",
        "last_updated": "2012-05-25",
        "status": "A",
        "authorized_official_last_name": "EBRAHIM",
        "authorized_official_first_name": "HOSSEIN",
        "authorized_official_middle_name": "KIA",
        "authorized_official_title_or_position": "PRESIDENT/DENTIST",
        "authorized_official_telephone_number": "949-350-6350",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": "36307",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": "37778",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in San Juan Capistrano, CA
• Providers in San Juan Capistrano, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.