Healthcare Provider Details

I. General information

NPI: 1447298047
Provider Name (Legal Business Name): AFSHIN GOLYAD DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12340 SANTA MONICA BLVD #241
LOS ANGELES CA
90025-2500
US

IV. Provider business mailing address

12340 SANTA MONICA BLVD #241
LOS ANGELES CA
90025-2500
US

V. Phone/Fax

Practice location:
  • Phone: 310-820-7010
  • Fax: 310-820-7060
Mailing address:
  • Phone: 310-820-7010
  • Fax: 310-820-7060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number43162
License Number StateCA

VIII. Authorized Official

Name: DR. AFSHIN GOLYAD
Title or Position: OWNER/PRESIDENT
Credential: DDS
Phone: 310-820-7010