Provider Demographics
NPI:1386053999
Name:HOSSEINI, HOUTAN I
Entity type:Individual
Prefix:DR
First Name:HOUTAN
Middle Name:
Last Name:HOSSEINI
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 34TH ST STE 100&200
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-2305
Mailing Address - Country:US
Mailing Address - Phone:833-678-2781
Mailing Address - Fax:661-368-0618
Practice Address - Street 1:625 34TH ST STE 100&200
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-2305
Practice Address - Country:US
Practice Address - Phone:833-678-2781
Practice Address - Fax:661-368-0618
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-07
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41923122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist