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General NPI Number Information
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NPI Number | 1659820686
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Entity Type | Organization
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Legal Business Name | PEGAH GHASSEMI BAKHTIARI DDS INC
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Dates
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Enumeration Date | 10/03/2016
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Last Update Date | 10/03/2016
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Provider Practice Location Address
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Address Line | 12756 WEST WASHINGTON BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90066
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Country | US
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Telephone | 310-822-6066
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Fax |
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Provider Business Mailing Address
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Address Line | 12756 W WASHINGTON BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90066-2309
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Country | US
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Telephone | 310-822-6066
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Fax |
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Authorized Official
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Title or Position | DR
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Name | MS. PEGAH GHASSEMI BAKHTIARI
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Credential | DDS
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Telephone | 818-632-5877
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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 | 64404
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License Number State | CA
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