Healthcare Provider Details

I. General information

NPI: 1720780125
Provider Name (Legal Business Name): LOS ANGELES DENTAL ANESTHESIA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16661 VENTURA BLVD STE 710
ENCINO CA
91436-1991
US

IV. Provider business mailing address

16661 VENTURA BLVD STE 710
ENCINO CA
91436-1991
US

V. Phone/Fax

Practice location:
  • Phone: 310-339-6264
  • Fax: 323-272-2614
Mailing address:
  • Phone: 310-339-6264
  • Fax: 323-272-2614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: AMIR ELIJAH RAD
Title or Position: CEO
Credential:
Phone: 310-339-6264