MEDICARE: DR. KAMYAR MORADIAN DDS

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
1	1223G0001X	General Practice Dentistry	105185	CA

General Provider Information

NPI Number	:	1396355590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KAMYAR MORADIAN DDS

Provider Business Mailing Address
First Line	:	1525 S CREST DR
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90035-3313
Country	:	US
Telephone Number	:	310-467-6318
Fax Number	:

Provider Business Practice Location Address
First Line	:	4717 LAUREL CANYON BLVD STE
Second Line	:	SUITE 200
City	:	LOS ANGELES
State	:	CA
Zip	:	90034-3324
Country	:	US
Telephone Number	:	310-467-6318
Fax Number	:	714-880-7420

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2020
Last Update Date	:	12/08/2025

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