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General NPI Number Information
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NPI Number | 1861882698
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Entity Type | Organization
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Legal Business Name | TARLAN, P. AKHAVAN DDS A PROF CORP
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Dates
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Enumeration Date | 02/02/2015
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Last Update Date | 02/02/2015
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Provider Practice Location Address
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Address Line | 2407 SOUTH VERMONT AVE
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City | LOS ANGELES
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State | CA
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Zip | 90007
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Country | US
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Telephone | 213-222-2990
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Fax |
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Provider Business Mailing Address
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Address Line | 2407 SOUTH VERMONT AVE
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City | LOS ANGELES
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State | CA
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Zip | 90007
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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 | TARLAN AKHAVAN
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Credential |
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Telephone | 213-222-2990
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 54323
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License Number State | CA
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