Healthcare Provider Details

I. General information

NPI: 1174291363
Provider Name (Legal Business Name): BIJAN AFAR DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2021
Last Update Date: 11/17/2022
Certification Date: 11/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 WILSHIRE BLVD
LOS ANGELES CA
90048-5801
US

IV. Provider business mailing address

6200 WILSHIRE BLVD
LOS ANGELES CA
90048-5801
US

V. Phone/Fax

Practice location:
  • Phone: 323-938-6137
  • Fax: 323-938-1336
Mailing address:
  • Phone: 323-938-6137
  • Fax: 323-938-1336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MARCELA MARTINEZ
Title or Position: OFFICE MANAGER
Credential:
Phone: 818-432-8300