Healthcare Provider Details

I. General information

NPI: 1629413547
Provider Name (Legal Business Name): JAVID AND NADI DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2013
Last Update Date: 06/02/2022
Certification Date: 06/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2104 PACIFIC COAST HWY
LOMITA CA
90717-2584
US

IV. Provider business mailing address

2104 PACIFIC COAST HWY
LOMITA CA
90717-2584
US

V. Phone/Fax

Practice location:
  • Phone: 310-539-1111
  • Fax:
Mailing address:
  • Phone: 310-539-1111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number48617
License Number StateCA

VIII. Authorized Official

Name: KAYVON HAKIMI JAVID
Title or Position: PRESIDENT
Credential: DDS
Phone: 310-539-1111