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General NPI Number Information
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NPI Number | 1720539042
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Entity Type | Organization
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Legal Business Name | K. JAVID DDS & M NADI DDS INC
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Dates
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Enumeration Date | 10/21/2016
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Last Update Date | 10/21/2016
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Provider Practice Location Address
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Address Line | 1622 S GAFFEY ST SUITE #102
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City | SAN PEDRO
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State | CA
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Zip | 90731-4658
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Country | US
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Telephone | 310-548-8128
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Fax | 310-539-4111
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Provider Business Mailing Address
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Address Line | 1622 S GAFFEY ST SUITE #102
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City | SAN PEDRO
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State | CA
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Zip | 90731-4658
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Country | US
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Telephone | 310-548-8128
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Fax | 310-539-4111
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Authorized Official
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Title or Position | OWNER/DDS
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Name | DR. KAYVON JAVID
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Credential | DDS
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Telephone | 310-548-8128
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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 | 48617
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License Number State | CA
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