Healthcare Provider Details

I. General information

NPI: 1275887812
Provider Name (Legal Business Name): COHEN, MANAVI & PAKRAVAN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2012
Last Update Date: 11/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17525 HIGHWAY 99
LYNNWOOD WA
98037-3105
US

IV. Provider business mailing address

17525 HIGHWAY 99
LYNNWOOD WA
98037-3105
US

V. Phone/Fax

Practice location:
  • Phone: 310-820-9933
  • Fax: 310-820-0408
Mailing address:
  • Phone: 310-820-9933
  • Fax: 310-820-0408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number39862
License Number StateCA

VIII. Authorized Official

Name: DR. FARID PAKRAVAN
Title or Position: OWNER
Credential:
Phone: 310-820-9933