Organization
HAMID COHEN KHERADYAR, DDS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HAMID COHEN KHERADYAR DDS (OWNER)
(310) 514-9100
Entity
Organization
Contact information
Practice address
138 S GAFFEY ST, SAN PEDRO, CA 90731-2430
(310) 514-9100
(310) 514-9119
Mailing address
138 S GAFFEY ST, SAN PEDRO, CA 90731-2430
(310) 514-9100
(310) 514-9119
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
39023
DENTIST
CA
01
—
444495
PERIODONTIST
CA
01
—
G89860
DENTI-CAL
CA
Enumeration date
07/10/2007
Last updated
07/10/2007
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