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General NPI Number Information
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NPI Number | 1821960758
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Entity Type | Individual
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Provider Name | JANA ABDULRAHIM
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Gender | Female
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Dates
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Enumeration Date | 09/20/2025
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Last Update Date | 09/20/2025
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Provider Practice Location Address
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Address Line | 19754 BEACH BLVD
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92648-2989
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Country | US
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Telephone | 714-964-8830
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Fax |
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Provider Business Mailing Address
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Address Line | 11110 CHARNOCK RD
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City | LOS ANGELES
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State | CA
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Zip | 90034-6507
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Country | US
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Telephone | 628-226-5516
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 111866
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License Number State | CA
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