Healthcare Provider Details

I. General information

NPI: 1700159050
Provider Name (Legal Business Name): ELENA AFSANEH YEGANEH-TAJIAN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2012
Last Update Date: 04/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 N ALMONT DR APT 301
BEVERLY HILLS CA
90211-1862
US

IV. Provider business mailing address

121 N ALMONT DR APT 301
BEVERLY HILLS CA
90211-1862
US

V. Phone/Fax

Practice location:
  • Phone: 310-903-1403
  • Fax:
Mailing address:
  • Phone: 310-903-1403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number61111
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: