Healthcare Provider Details

I. General information

NPI: 1023927167
Provider Name (Legal Business Name): DANIEL KHORAMIAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4654 E AVENUE S STE A
PALMDALE CA
93552-4454
US

IV. Provider business mailing address

17412 VENTURA BLVD # 16
ENCINO CA
91316-3827
US

V. Phone/Fax

Practice location:
  • Phone: 818-917-4318
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number113781
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: