Healthcare Provider Details

I. General information

NPI: 1235790189
Provider Name (Legal Business Name): ANAHITA BEHSHADPOUR DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2019
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14435 HAMLIN ST STE 205
VAN NUYS CA
91401-6205
US

IV. Provider business mailing address

14435 HAMLIN ST STE 205
VAN NUYS CA
91401-6205
US

V. Phone/Fax

Practice location:
  • Phone: 818-997-6300
  • Fax:
Mailing address:
  • Phone: 818-997-6300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number103803
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number103803
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberS4-135C
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: