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General NPI Number Information
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NPI Number | 1689919995
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Entity Type | Organization
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Legal Business Name | COHEN SEDGH, MANAVI & PAKRAVAN DENTAL CORPORATION
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Dates
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Enumeration Date | 11/28/2012
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Last Update Date | 11/28/2012
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Provider Practice Location Address
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Address Line | 1423 E GAGE AVE SUITE A
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City | LOS ANGELES
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State | CA
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Zip | 90001-1771
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Country | US
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Telephone | 323-983-4000
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Fax | 323-983-4007
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Provider Business Mailing Address
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Address Line | 1423 E GAGE AVE SUITE A
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City | LOS ANGELES
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State | CA
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Zip | 90001-1771
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Country | US
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Telephone | 323-983-4000
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Fax | 323-983-4007
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Authorized Official
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Title or Position | OWNER
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Name | DR. FARID PAKRAVAN
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Credential |
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Telephone | 310-820-9933
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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 | 39862
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License Number State | CA
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