Healthcare Provider Details

I. General information

NPI: 1871649152
Provider Name (Legal Business Name): HEDI KERMANI DDS, MDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEDIEH TAVAJOHI-KERMANI DDS, MDS

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 08/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14119 PIONEER BLVD
NORWALK CA
90650-3925
US

IV. Provider business mailing address

2549 EASTBLUFF DR STE B #415
NEWPORT BEACH CA
92660-3500
US

V. Phone/Fax

Practice location:
  • Phone: 562-929-2383
  • Fax: 323-249-7565
Mailing address:
  • Phone: 949-640-5050
  • Fax: 949-640-5051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number43565
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: