MEDICARE: NEDA KAKVAND

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	124Q00000X	Dental Hygienist

General Provider Information

NPI Number	:	1598220980
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NEDA KAKVAND

Provider Business Mailing Address
First Line	:	11511 MOORPARK ST # 7
Second Line	:
City	:	STUDIO CITY
State	:	CA
Zip	:	91602-1924
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8020 LAUREL CANYON BLVD
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91605-1427
Country	:	US
Telephone Number	:	818-759-1001
Fax Number	:

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

Provider Enumeration Date	:	02/10/2019
Last Update Date	:	02/10/2019

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