MEDICARE: DR. TARLAN P AKHAVAN D.D.S

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	122300000X	Dentist	54323	CA

General Provider Information

NPI Number	:	1598828717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TARLAN P AKHAVAN D.D.S

Provider Business Mailing Address
First Line	:	530 E WASHINGTON BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90015-3723
Country	:	US
Telephone Number	:	213-222-2990
Fax Number	:	213-222-2972

Provider Business Practice Location Address
First Line	:	530 E WASHINGTON BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90015-3723
Country	:	US
Telephone Number	:	213-222-2990
Fax Number	:	213-222-2972

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

Provider Enumeration Date	:	12/18/2006
Last Update Date	:	01/10/2014

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