Healthcare Provider Details

I. General information

NPI: 1457655425
Provider Name (Legal Business Name): COHEN SEDGH, MANAVI & PAKRAVAN DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2011
Last Update Date: 06/27/2022
Certification Date: 06/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21229 HAWTHORNE BLVD SUITE A
TORRANCE CA
90503-5501
US

IV. Provider business mailing address

21229 HAWTHORNE BLVD SUITE A
TORRANCE CA
90503-5501
US

V. Phone/Fax

Practice location:
  • Phone: 310-792-5600
  • Fax: 310-792-5628
Mailing address:
  • Phone: 310-792-5600
  • Fax: 310-792-5628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number38979
License Number StateCA

VIII. Authorized Official

Name: SOLEYMAN COHEN SEDGH
Title or Position: PRESIDENT
Credential: DDS
Phone: 310-820-9933