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General NPI Number Information
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NPI Number | 1710332838
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Entity Type | Organization
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Legal Business Name | TAJIK NAMINIK & KOSHKI DDS INC
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Dates
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Enumeration Date | 04/26/2016
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Last Update Date | 04/26/2016
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Provider Practice Location Address
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Address Line | 10545 VICTORY BLVD
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City | NORTH HOLLYWOOD
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State | CA
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Zip | 91606-3916
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Country | US
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Telephone | 818-763-9353
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Fax | 818-763-6227
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Provider Business Mailing Address
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Address Line | 10545 VICTORY BLVD
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City | NORTH HOLLYWOOD
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State | CA
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Zip | 91606-3916
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Country | US
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Telephone | 818-763-9353
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Fax | 818-763-6227
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Authorized Official
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Title or Position | DENTIST
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Name | DR. KASRA TAJIK
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Credential | DDS
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Telephone | 818-763-9395
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 63665
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License Number State | CA
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