Healthcare Provider Details

I. General information

NPI: 1508792177
Provider Name (Legal Business Name): NIMA MICHAEL NIKRAVESH DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 W GONZALES RD STE C
OXNARD CA
93036-7789
US

IV. Provider business mailing address

137 S CLARK DR
BEVERLY HILLS CA
90211-2603
US

V. Phone/Fax

Practice location:
  • Phone: 805-203-9710
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number113192
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: