MEDICARE: AFSHIN GOLYAD DDS INC

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	261QD0000X	Dental Clinic/Center	43162	CA

General Provider Information

NPI Number	:	1447298047
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AFSHIN GOLYAD DDS INC

Provider Business Mailing Address
First Line	:	12340 SANTA MONICA BLVD
Second Line	:	#241
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-2500
Country	:	US
Telephone Number	:	310-820-7010
Fax Number	:	310-820-7060

Provider Business Practice Location Address
First Line	:	12340 SANTA MONICA BLVD
Second Line	:	#241
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-2500
Country	:	US
Telephone Number	:	310-820-7010
Fax Number	:	310-820-7060

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	DR. AFSHIN GOLYAD
Credential	:	DDS
Telephone Number	:	310-820-7010

Provider Enumeration Date	:	06/04/2006
Last Update Date	:	06/16/2008

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