Healthcare Provider Details

I. General information

NPI: 1295187474
Provider Name (Legal Business Name): COHEN SEDGH, MANAVI & PAKRAVAN DENTAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2016
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30035 HAUN RD UNIT B
MENIFEE CA
92584-6805
US

IV. Provider business mailing address

30035 HAUN ROAD
MENIFEE CA
92584
US

V. Phone/Fax

Practice location:
  • Phone: 310-820-9933
  • Fax: 310-820-0408
Mailing address:
  • Phone: 310-820-9933
  • Fax: 310-820-0408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number38558
License Number StateCA

VIII. Authorized Official

Name: DR. FARHAD MANAVI
Title or Position: OWNER
Credential: DDS
Phone: 310-820-9933