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General NPI Number Information
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NPI Number | 1851197750
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Entity Type | Organization
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Legal Business Name | KEIVAN SARRAF, DDS, INC
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Dates
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Enumeration Date | 02/21/2025
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Last Update Date | 02/21/2025
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Provider Practice Location Address
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Address Line | 2700 N BROADWAY
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City | LOS ANGELES
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State | CA
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Zip | 90031-2610
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Country | US
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Telephone | 323-751-5600
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Fax |
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Provider Business Mailing Address
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Address Line | 11341 NATIONAL BLVD PMB 1090
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City | LOS ANGELES
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State | CA
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Zip | 90064-3726
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | KEIVAN SARRAF
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Credential | DDS
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Telephone | 310-460-9546
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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