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General NPI Number Information
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NPI Number | 1235623190
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Entity Type | Organization
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Legal Business Name | KOHAN & RODEF DENTAL CORPORATION
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Dates
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Enumeration Date | 06/14/2018
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Last Update Date | 01/23/2026
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Provider Practice Location Address
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Address Line | 500 SAN FERNANDO MISSION BLVD #110
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City | SAN FERNARDO
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State | CA
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Zip | 91340-4061
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Country | US
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Telephone | 818-403-6722
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Fax | 747-253-7532
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Provider Business Mailing Address
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Address Line | 2235A E. GARVEY AVE N.
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City | WEST COVINA
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State | CA
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Zip | 91791-1500
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Country | US
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Telephone | 626-412-0200
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Fax | 626-214-0037
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Authorized Official
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Title or Position | OWNER
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Name | MR. FARIBORZ RODEF
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Credential | DDS
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Telephone | 626-412-0200
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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 | 62906
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 38356
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License Number State | CA
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