Healthcare Provider Details

I. General information

NPI: 1609485317
Provider Name (Legal Business Name): DANIEL KEYVANI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2020
Last Update Date: 10/12/2023
Certification Date: 01/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12204 VENTURA BLVD
STUDIO CITY CA
91604-2518
US

IV. Provider business mailing address

9400 BRIGHTON WAY STE 410
BEVERLY HILLS CA
90210-4711
US

V. Phone/Fax

Practice location:
  • Phone: 818-308-7703
  • Fax:
Mailing address:
  • Phone: 310-860-6969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDDS103372
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: