Healthcare Provider Details

I. General information

NPI: 1528363207
Provider Name (Legal Business Name): COHEN SEDGH, MANAVI & PAKRAVAN DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2011
Last Update Date: 08/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 W 6TH ST
LOS ANGELES CA
90017-1000
US

IV. Provider business mailing address

1725 W 6TH ST
LOS ANGELES CA
90017-1000
US

V. Phone/Fax

Practice location:
  • Phone: 213-413-5151
  • Fax: 213-413-7171
Mailing address:
  • Phone: 213-413-5151
  • Fax: 213-413-7171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number39862
License Number StateCA

VIII. Authorized Official

Name: FARID PAKRAVAN
Title or Position: OWNER
Credential:
Phone: 310-820-9933