Provider Demographics
NPI:1528276300
Name:MOIN, IRAJ (DDS)
Entity type:Individual
Prefix:DR
First Name:IRAJ
Middle Name:
Last Name:MOIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5216 LAUREL CANYON BLVD
Mailing Address - Street 2:
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-2710
Mailing Address - Country:US
Mailing Address - Phone:818-985-1848
Mailing Address - Fax:818-985-1989
Practice Address - Street 1:5216 LAUREL CANYON BLVD
Practice Address - Street 2:
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-2710
Practice Address - Country:US
Practice Address - Phone:818-985-1848
Practice Address - Fax:818-985-1989
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA333421223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics