MEDICARE: COHEN SEDGH, MANAVI & PAKRAVAN 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	122300000X	Dentist	38558	CA

General Provider Information

NPI Number	:	1861789513
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COHEN SEDGH, MANAVI & PAKRAVAN DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	1835 XIMENO AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90815-2850
Country	:	US
Telephone Number	:	310-820-9933
Fax Number	:	310-820-0408

Provider Business Practice Location Address
First Line	:	1835 XIMENO AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90815-2850
Country	:	US
Telephone Number	:	310-820-9933
Fax Number	:	310-820-0408

Authorized Official
Title or Position	:	OWNER
Name	:	FARHAD MANAVI
Credential	:	DDS
Telephone Number	:	310-820-9933

Provider Enumeration Date	:	07/01/2011
Last Update Date	:	07/01/2011

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