Healthcare Provider Details

I. General information

NPI: 1669231460
Provider Name (Legal Business Name): DANIEL KOHANGHADOSH DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2024
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40706 WINCHESTER RD
TEMECULA CA
92591
US

IV. Provider business mailing address

6660 DREXEL AVE
LOS ANGELES CA
90048-4209
US

V. Phone/Fax

Practice location:
  • Phone: 310-873-8372
  • Fax:
Mailing address:
  • Phone: 310-873-8372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number110447
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number110447
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: