Healthcare Provider Details

I. General information

NPI: 1952191405
Provider Name (Legal Business Name): TIKLAT ISSA DDS CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2025
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 EDINGER AVE
HUNTINGTON BEACH CA
92649-2301
US

IV. Provider business mailing address

4440 E VILLAGE RD
LONG BEACH CA
90808-1540
US

V. Phone/Fax

Practice location:
  • Phone: 714-846-4411
  • Fax:
Mailing address:
  • Phone: 562-425-3311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. TIKLAT ISSA
Title or Position: DENTIST/OWNER
Credential: DDS
Phone: 714-846-4411