Healthcare Provider Details

I. General information

NPI: 1699320671
Provider Name (Legal Business Name): YEHONATAN MIZRAHI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2019
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16260 VENTURA BLVD STE 404
ENCINO CA
91436-2238
US

IV. Provider business mailing address

4400 CORONET DR
ENCINO CA
91316-4325
US

V. Phone/Fax

Practice location:
  • Phone: 818-986-7411
  • Fax:
Mailing address:
  • Phone: 310-595-5584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number104179
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: