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General NPI Number Information
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NPI Number | 1043518384
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Entity Type | Organization
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Legal Business Name | AMIN KOHANBASH DDS INC
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Dates
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Enumeration Date | 03/10/2011
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Last Update Date | 03/10/2011
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Provider Practice Location Address
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Address Line | 14523 SHERMAN WAY # A
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City | VAN NUYS
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State | CA
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Zip | 91405-2211
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Country | US
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Telephone | 818-787-7300
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Fax |
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Provider Business Mailing Address
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Address Line | 14523 SHERMAN WAY # A
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City | VAN NUYS
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State | CA
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Zip | 91405-2211
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | AMIN KOHANBASH
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Credential |
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Telephone | 818-458-6526
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 41745
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License Number State | CA
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