Healthcare Provider Details

I. General information

NPI: 1699156547
Provider Name (Legal Business Name): SARAVANAN RAM DDS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2015
Last Update Date: 06/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16311 VENTURA BLVD STE 1250
ENCINO CA
91436-2124
US

IV. Provider business mailing address

16311 VENTURA BLVD STE 1250
ENCINO CA
91436-2124
US

V. Phone/Fax

Practice location:
  • Phone: 818-789-0555
  • Fax: 818-789-5011
Mailing address:
  • Phone: 818-789-0555
  • Fax: 818-789-5011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number59462
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number59462
License Number StateCA

VIII. Authorized Official

Name: DR. SARAVANAN RAM
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 213-268-7478