Healthcare Provider Details

I. General information

NPI: 1851046643
Provider Name (Legal Business Name): JULIET EBRAHIMIAN DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2022
Last Update Date: 06/10/2024
Certification Date: 06/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 FAIR OAKS AVE STE B
SOUTH PASADENA CA
91030-2675
US

IV. Provider business mailing address

2129 E GLENOAKS BLVD
GLENDALE CA
91206-2933
US

V. Phone/Fax

Practice location:
  • Phone: 626-421-7171
  • Fax:
Mailing address:
  • Phone: 818-307-0416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JULIET EBRAHIMIAN
Title or Position: DENTIST
Credential: DDS
Phone: 818-307-0416