Healthcare Provider Details

I. General information

NPI: 1790334134
Provider Name (Legal Business Name): RODEF & YOUSEFI DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2019
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3736 CRENSHAW BLVD
LOS ANGELES CA
90016
US

IV. Provider business mailing address

2235 E GARVEY AVE N STE A
WEST COVINA CA
91791-1540
US

V. Phone/Fax

Practice location:
  • Phone: 626-412-0200
  • Fax: 626-214-0037
Mailing address:
  • Phone: 626-412-0200
  • Fax: 626-214-0033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: FARIBORZ RODEF
Title or Position: CEO
Credential:
Phone: 310-625-3773