Healthcare Provider Details

I. General information

NPI: 1013320597
Provider Name (Legal Business Name): NOOSHI AKAVAN DDS, MS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2014
Last Update Date: 06/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18919 VENTURA BLVD SUITE B
TARZANA CA
91356-3211
US

IV. Provider business mailing address

18919 VENTURA BLVD SUITE B
TARZANA CA
91356-3211
US

V. Phone/Fax

Practice location:
  • Phone: 818-345-9601
  • Fax: 818-757-8901
Mailing address:
  • Phone: 818-345-9601
  • Fax: 818-757-8901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number38020
License Number StateCA

VIII. Authorized Official

Name: DR. NOOSHI AKAVAN
Title or Position: OWNER/ ORTHODONTIST
Credential: DDS, MS
Phone: 818-345-9601