Healthcare Provider Details

I. General information

NPI: 1467506964
Provider Name (Legal Business Name): SAHABI-SEPAHI-ARGHAVANIFARD DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 08/04/2020
Certification Date: 08/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10400 MAGNOLIA BLVD
NORTH HOLLYWOOD CA
91601-4108
US

IV. Provider business mailing address

10400 MAGNOLIA BLVD
NORTH HOLLYWOOD CA
91601-4108
US

V. Phone/Fax

Practice location:
  • Phone: 818-762-4440
  • Fax: 818-762-4211
Mailing address:
  • Phone: 818-762-4440
  • Fax: 818-762-4211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. KEYVAN ARGHAVANIFARD
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 310-801-0282