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General NPI Number Information
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NPI Number | 1891345112
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Entity Type | Individual
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Provider Name | MICHAEL PEDRAM DDS, MD
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Gender | Male
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Dates
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Enumeration Date | 09/18/2019
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Last Update Date | 07/28/2025
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Provider Practice Location Address
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Address Line | 5363 BALBOA BLVD STE 233
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City | ENCINO
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State | CA
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Zip | 91316-2824
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Country | US
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Telephone | 818-788-4424
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Fax |
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Provider Business Mailing Address
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Address Line | 1560 LOMA VISTA DR
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City | BEVERLY HILLS
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State | CA
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Zip | 90210-1939
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Country | US
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Telephone | 310-612-4365
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 104435
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License Number State | CA
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