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General NPI Number Information
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NPI Number | 1861510745
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Entity Type | Individual
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Provider Name | NAZLY KHORSANDI DDS.
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Gender | Female
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 04/17/2015
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Provider Practice Location Address
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Address Line | 16500 VENTURA BLVD. SUITE 150
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City | ENCINO
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State | CA
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Zip | 91436
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Country | US
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Telephone | 818-907-1818
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Fax | 310-899-5111
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Provider Business Mailing Address
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Address Line | 626 11TH ST
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City | SANTA MONICA
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State | CA
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Zip | 90402
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Country | US
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Telephone | 310-435-8184
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Fax | 310-899-5111
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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 | 40251
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 40251
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License Number State | CA
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