Healthcare Provider Details

I. General information

NPI: 1578321469
Provider Name (Legal Business Name): OLIVER KHORSANDI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2024
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 W RANCHO VISTA BLVD
PALMDALE CA
93551-3735
US

IV. Provider business mailing address

619 N HILLCREST RD
BEVERLY HILLS CA
90210-3514
US

V. Phone/Fax

Practice location:
  • Phone: 661-265-7800
  • Fax:
Mailing address:
  • Phone: 310-601-6898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDDS109766
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: