MEDICARE: JANJIK & RODEF DENTAL CORPORATION

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	1223P0221X	Pediatric Dentistry	51046	CA

General Provider Information

NPI Number	:	1770642548
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JANJIK & RODEF DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	1501 COLORADO BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90041-1424
Country	:	US
Telephone Number	:	323-255-9663
Fax Number	:	323-255-9634

Provider Business Practice Location Address
First Line	:	1501 COLORADO BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90041-1424
Country	:	US
Telephone Number	:	323-255-9663
Fax Number	:	323-255-9634

Authorized Official
Title or Position	:	OWNER/CEO
Name	:	DR. FARIBORZ RODEF
Credential	:
Telephone Number	:	626-412-0200

Provider Enumeration Date	:	12/08/2006
Last Update Date	:	02/28/2022

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