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General NPI Number Information
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NPI Number | 1548122690
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Entity Type | Organization
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Legal Business Name | S. KHODADADI DENTAL CORPORATION
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Dates
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Enumeration Date | 11/26/2025
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Last Update Date | 11/26/2025
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Provider Practice Location Address
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Address Line | 1305 SEPULVEDA BLVD UNIT 2
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City | TORRANCE
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State | CA
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Zip | 90501-5002
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Country | US
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Telephone | 310-666-9024
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Fax |
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Provider Business Mailing Address
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Address Line | 200 N SWALL DR UNIT 504
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City | BEVERLY HILLS
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State | CA
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Zip | 90211-4725
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Country | US
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Telephone | 310-666-9024
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHAEL NEDJAT-HAIEM
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Credential | DDS
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Telephone | 310-666-9024
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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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