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Organization
KHASHAYAR KHODADADI DDS INC
Active
Organization
KHASHAYAR KHODADADI DDS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KHASHAYAR KHODADADI D.D.S (PRESIDENT)
(323) 834-0100
Entity
Organization
Contact information
Practice address
11900 S. AVALON BLVD., SUITE 101, LOS ANGELES, CA 90061
(323) 834-0100
(323) 834-0101
Mailing address
11900 S. AVALON BLVD., SUITE 101, LOS ANGELES, CA 90061
(323) 834-0100
(323) 834-0101
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
43026
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G93919-01
DENTI-CAL PROVIDER NUMBER
CA
Enumeration date
04/19/2007
Last updated
06/14/2010
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