Provider Demographics
NPI:1396136974
Name:KATAYOUN OMRANI, DDS A PROFESSIONAL DENTAL CORPORATION
Entity type:Organization
Organization Name:KATAYOUN OMRANI, DDS A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:KATAYOUN
Authorized Official - Middle Name:
Authorized Official - Last Name:OMRANI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-422-4246
Mailing Address - Street 1:11600 WILSHIRE BLVD STE 406
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-1785
Mailing Address - Country:US
Mailing Address - Phone:310-422-4246
Mailing Address - Fax:
Practice Address - Street 1:11600 WILSHIRE BLVD STE 406
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-1785
Practice Address - Country:US
Practice Address - Phone:310-422-4246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-18
Last Update Date:2025-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45399122300000X
1223X2210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X2210XDental ProvidersDentistOrofacial PainGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty