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General NPI Number Information
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NPI Number | 1336383843
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Entity Type | Organization
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Legal Business Name | ALI KHOSROVANI DDS INC
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Dates
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Enumeration Date | 04/28/2009
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Last Update Date | 09/23/2020
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Provider Practice Location Address
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Address Line | 4905 YORK BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90042-1609
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Country | US
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Telephone | 323-255-8774
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Fax | 323-255-6259
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Provider Business Mailing Address
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Address Line | 4905 YORK BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90042-1609
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Country | US
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Telephone | 323-255-8774
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Fax | 323-255-6259
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Authorized Official
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Title or Position | OWNER DENTIST
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Name | ALI M KHOSROVANI
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Credential | DDS
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Telephone | 323-255-8774
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 56085
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License Number State | CA
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