Healthcare Provider Details

I. General information

NPI: 1407489164
Provider Name (Legal Business Name): MEHRNOOSH AKHAVAN DDS, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2020
Last Update Date: 12/17/2021
Certification Date: 12/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18919 VENTURA BLVD STE B
TARZANA CA
91356-3211
US

IV. Provider business mailing address

18919 VENTURA BLVD STE 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:

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:
Title or Position:
Credential:
Phone: