Provider Demographics
NPI:1962166355
Name:BOZORGMANESH CORP
Entity type:Organization
Organization Name:BOZORGMANESH CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:SOHA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAGHANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-873-8353
Mailing Address - Street 1:38 PROMONTORY PARK
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-3380
Mailing Address - Country:US
Mailing Address - Phone:310-873-8353
Mailing Address - Fax:
Practice Address - Street 1:26741 PORTOLA PKWY STE 1D
Practice Address - Street 2:
Practice Address - City:FOOTHILL RANCH
Practice Address - State:CA
Practice Address - Zip Code:92610-1762
Practice Address - Country:US
Practice Address - Phone:949-581-4908
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-22
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty