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General NPI Number Information
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NPI Number | 1972026920
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Entity Type | Organization
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Legal Business Name | COHEN SEDGH, MANAVI & PAKRAVAN DENTAL CORP
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Dates
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Enumeration Date | 07/21/2017
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Last Update Date | 07/21/2017
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Provider Practice Location Address
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Address Line | 3027 W FLORIDA AVE # P-1
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City | HEMET
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State | CA
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Zip | 92545-3617
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Country | US
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Telephone | 310-409-4225
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Fax | 310-820-0408
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Provider Business Mailing Address
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Address Line | 12121 WILSHIRE BLVD STE 1111
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City | LOS ANGELES
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State | CA
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Zip | 90025-1188
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Country | US
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Telephone | 310-820-9933
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Fax | 310-820-0408
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Authorized Official
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Title or Position | Q/A CONTRACT & COMPLIANCE MANAGER
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Name | MIGUEL REYES
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Credential |
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Telephone | 310-820-9933
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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 | 39862
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License Number State | CA
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