| NPI | 1598056624 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK SHAHRAM YAFAI Owner 310-892-1969 |
| Organization Subpart ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: CA A104572) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 50117) |
| Enumeration Date | 2011-04-23 |
| Last Update Date | 2016-06-20 |