Healthcare Provider Details

I. General information

NPI: 1730667411
Provider Name (Legal Business Name): VAHAG MEHRABIAN DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2018
Last Update Date: 08/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5815 WHITTIER BLVD
LOS ANGELES CA
90022-4301
US

IV. Provider business mailing address

5815 WHITTIER BLVD
LOS ANGELES CA
90022-4301
US

V. Phone/Fax

Practice location:
  • Phone: 323-721-1212
  • Fax: 323-721-2002
Mailing address:
  • Phone: 323-721-1212
  • Fax: 323-721-2002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number51108
License Number StateCA

VIII. Authorized Official

Name: DR. VAHAG MEHRABIAN
Title or Position: PRESIDENT
Credential: DDS
Phone: 323-721-1212