Healthcare Provider Details

I. General information

NPI: 1275389652
Provider Name (Legal Business Name): TARA NAKJIRI,DDS.INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2024
Last Update Date: 04/26/2024
Certification Date: 04/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

436 N ROXBURY DR STE NPH
BEVERLY HILLS CA
90210-5026
US

IV. Provider business mailing address

436 N ROXBURY DR STE NPH
BEVERLY HILLS CA
90210-5026
US

V. Phone/Fax

Practice location:
  • Phone: 310-271-0461
  • Fax: 310-271-1821
Mailing address:
  • Phone: 310-271-0461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. TARA NAKJIRI
Title or Position: DENTIST
Credential: DDS
Phone: 310-666-0672