MEDICARE: JAVID AND NADI 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	261QS0112X	Oral and Maxillofacial Surgery Clinic/Center

General Provider Information

NPI Number	:	1871221846
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAVID AND NADI DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	2104 PACIFIC COAST HWY STE 5
Second Line	:
City	:	LOMITA
State	:	CA
Zip	:	90717-2594
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2104 PACIFIC COAST HWY STE 5
Second Line	:
City	:	LOMITA
State	:	CA
Zip	:	90717-2594
Country	:	US
Telephone Number	:	310-325-8555
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KAYVON JAVID
Credential	:
Telephone Number	:	310-325-8555

Provider Enumeration Date	:	08/09/2022
Last Update Date	:	08/09/2022

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