Provider Demographics
NPI:1629627716
Name:IMANI EMADI, MOHAMMAD MEHDI (DDS, MS)
Entity type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:MEHDI
Last Name:IMANI EMADI
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:TIRAKHSH
Other - Middle Name:
Other - Last Name:EMADI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS, MS
Mailing Address - Street 1:3918 LONG BEACH BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-2685
Mailing Address - Country:US
Mailing Address - Phone:562-242-2075
Mailing Address - Fax:
Practice Address - Street 1:3918 LONG BEACH BLVD STE 200
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-2685
Practice Address - Country:US
Practice Address - Phone:562-242-2075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-10
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX357101223P0700X
CA1083511223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty