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General NPI Number Information
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NPI Number | 1538456108
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Entity Type | Individual
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Provider Name | AFSANEH KADKHODA
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Gender | Female
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Dates
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Enumeration Date | 07/05/2011
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Last Update Date | 10/29/2015
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Provider Practice Location Address
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Address Line | 17550 COLIN'S STREET
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City | ENCINO
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State | CA
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Zip | 91316-5762
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Country | US
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Telephone | 310-595-4605
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Fax |
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Provider Business Mailing Address
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Address Line | 1801 GIBSON BLVD SE
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City | ALBUQUERQUE
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State | NM
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Zip | 87106-3348
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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 |
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Name |
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Credential |
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Telephone |
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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 | 60406
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DD4063
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License Number State | NM
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