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General NPI Number Information
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NPI Number | 1003033556
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Entity Type | Organization
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Legal Business Name | KHASHAYAR KHODADADI DDS INC
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 06/14/2010
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Provider Practice Location Address
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Address Line | 11900 S. AVALON BLVD. SUITE 101
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City | LOS ANGELES
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State | CA
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Zip | 90061
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Country | US
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Telephone | 323-834-0100
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Fax | 323-834-0101
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Provider Business Mailing Address
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Address Line | 11900 S. AVALON BLVD. SUITE 101
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City | LOS ANGELES
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State | CA
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Zip | 90061
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Country | US
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Telephone | 323-834-0100
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Fax | 323-834-0101
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KHASHAYAR KHODADADI
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Credential | D.D.S
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Telephone | 323-834-0100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 43026
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License Number State | CA
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