=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255207767
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KATAYOUN TAJIK DDS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/13/2025
-----------------------------------------------------
Last Update Date | 10/22/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11668 W OLYMPIC BLVD
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90064-1437
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-435-3453
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11668 W OLYMPIC BLVD STE 201
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90064-1438
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-394-2221
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. KATAYOUN TAJIK
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 310-435-3453
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------