Healthcare Provider Details

I. General information

NPI: 1285873075
Provider Name (Legal Business Name): MAYA JOHAR D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2009
Last Update Date: 05/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9201 W SUNSET BLVD STE 609
LOS ANGELES CA
90069-3707
US

IV. Provider business mailing address

9201 W SUNSET BLVD STE 609
LOS ANGELES CA
90069-3707
US

V. Phone/Fax

Practice location:
  • Phone: 310-422-1509
  • Fax:
Mailing address:
  • Phone: 310-422-1509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number58744
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number009953
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: