Healthcare Provider Details

I. General information

NPI: 1497278725
Provider Name (Legal Business Name): JOSEPH BABAK BEHJAT DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2017
Last Update Date: 07/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

593 N MOORPARK RD STE B
THOUSAND OAKS CA
91360-3732
US

IV. Provider business mailing address

1530 HIGHPOINT ST
UPLAND CA
91784-8613
US

V. Phone/Fax

Practice location:
  • Phone: 805-494-5255
  • Fax:
Mailing address:
  • Phone: 909-519-2983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number101581
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: