Provider Demographics
NPI:1215051453
Name:KOUROSH HARANDI DDS. MS. INC.
Entity type:Organization
Organization Name:KOUROSH HARANDI DDS. MS. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KOUROSH
Authorized Official - Middle Name:
Authorized Official - Last Name:HARANDI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:510-724-3666
Mailing Address - Street 1:1500 TARA HILLS DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PINOLE
Mailing Address - State:CA
Mailing Address - Zip Code:94564-2577
Mailing Address - Country:US
Mailing Address - Phone:510-724-3666
Mailing Address - Fax:510-724-5923
Practice Address - Street 1:1500 TARA HILLS DR
Practice Address - Street 2:SUITE 202
Practice Address - City:PINOLE
Practice Address - State:CA
Practice Address - Zip Code:94564-2577
Practice Address - Country:US
Practice Address - Phone:510-724-3666
Practice Address - Fax:510-724-5923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52802261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental