Healthcare Provider Details

I. General information

NPI: 1104714682
Provider Name (Legal Business Name): ELISHA HAYKANI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2025
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18232 WEDDINGTON ST
TARZANA CA
91356-3620
US

IV. Provider business mailing address

18232 WEDDINGTON ST
TARZANA CA
91356-3620
US

V. Phone/Fax

Practice location:
  • Phone: 310-414-7703
  • Fax:
Mailing address:
  • Phone: 310-414-7703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDDS109873
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: