Healthcare Provider Details

I. General information

NPI: 1427754415
Provider Name (Legal Business Name): MEHRAN EVINI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2023
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6817 BALBOA BLVD STE A
VAN NUYS CA
91406-4592
US

IV. Provider business mailing address

6817 BALBOA BLVD STE A
VAN NUYS CA
91406-4592
US

V. Phone/Fax

Practice location:
  • Phone: 310-866-0203
  • Fax:
Mailing address:
  • Phone: 310-866-0203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number108546
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: