Healthcare Provider Details

I. General information

NPI: 1265845564
Provider Name (Legal Business Name): KOAHNOF AND ZARABIAN DDS DENTAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2014
Last Update Date: 06/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15300 DEVONSHIRE ST STE 6
MISSION HILLS CA
91345-2758
US

IV. Provider business mailing address

15300 DEVONSHIRE ST STE 6
MISSION HILLS CA
91345-2758
US

V. Phone/Fax

Practice location:
  • Phone: 818-894-6411
  • Fax:
Mailing address:
  • Phone: 818-894-6411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number59573
License Number StateCA

VIII. Authorized Official

Name: KAVEH KOHANOF
Title or Position: OWNER
Credential: DDS
Phone: 818-605-7917