MEDICARE: RONAN RAHIMI DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	59163	CA
2	122300000X	Dentist	22DI02397100	NJ

General Provider Information

NPI Number	:	1649406638
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONAN RAHIMI DMD

Provider Business Mailing Address
First Line	:	1260 S BEVERLY GLEN BLVD APT 201
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-5220
Country	:	US
Telephone Number	:	201-927-9505
Fax Number	:

Provider Business Practice Location Address
First Line	:	1537 S SHENANDOAH ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90035-4480
Country	:	US
Telephone Number	:	310-735-4356
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2009
Last Update Date	:	02/13/2026

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Directions to “ RONAN RAHIMI DMD” Practice Location

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