Provider Demographics
NPI:1679019681
Name:OSAFI, JAVID FARAN (DMD)
Entity type:Individual
Prefix:DR
First Name:JAVID
Middle Name:FARAN
Last Name:OSAFI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4980 BARRANCA PKWY STE 206
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-8655
Mailing Address - Country:US
Mailing Address - Phone:702-612-0687
Mailing Address - Fax:
Practice Address - Street 1:29645 RANCHO CALIFORNIA RD STE 229
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-5285
Practice Address - Country:US
Practice Address - Phone:425-223-3522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-13
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0119691223G0001X
WADE607450791223P0221X
CA1012921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2080083Medicaid