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NPI Code Detail

MEDICARE: EDALAT PAJOUH S KALAI DENTAL CORP

MEDICARE: EDALAT PAJOUH S KALAI DENTAL CORP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist41739CA

General Provider Information

NPI Number : 1205908795
Entity Type Code : Organization
Provider Name (Legal Business Name) : EDALAT PAJOUH S KALAI DENTAL CORP
Provider Business Mailing Address
First Line : 6832 DESOTO AVE
Second Line :
City : CANOGA PARK
State : CA
Zip : 91303
Country : US
Telephone Number : 818-888-2211
Fax Number : 818-888-2915
Provider Business Practice Location Address
First Line : 6832 DESOTO AVE
Second Line :
City : CANOGA PARK
State : CA
Zip : 91303
Country : US
Telephone Number : 818-888-2211
Fax Number : 818-888-2915
Authorized Official
Title or Position : SECRETARY
Name : KAMBIZ KALAI
Credential : DDS
Telephone Number : 818-888-2211
Provider Enumeration Date : 11/14/2006
Last Update Date : 09/17/2008

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Directions to “EDALAT PAJOUH S KALAI DENTAL CORP ” Practice Location

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