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General NPI Number Information
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NPI Number | 1518585116
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Entity Type | Organization
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Legal Business Name | NASRIN KHORRAM DENTAL CORP.
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Dates
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Enumeration Date | 07/09/2020
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Last Update Date | 07/09/2020
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Provider Practice Location Address
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Address Line | 21914 VENTURA BLVD
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City | WOODLAND HILLS
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State | CA
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Zip | 91364-1724
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Country | US
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Telephone | 310-570-3207
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Fax |
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Provider Business Mailing Address
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Address Line | 944 BERKELEY ST
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City | SANTA MONICA
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State | CA
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Zip | 90403-2308
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Country | US
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Telephone | 310-570-3207
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Fax |
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Authorized Official
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Title or Position | OWNER DENTIST
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Name | NASRIN KHORRAM
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Credential | DDS
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Telephone | 310-570-3207
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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 |
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License Number State |
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