Provider Demographics
NPI:1003115312
Name:H.R.IMANKHAN,DDS,INC
Entity Type:Organization
Organization Name:H.R.IMANKHAN,DDS,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HAMID
Authorized Official - Middle Name:REZA
Authorized Official - Last Name:IMANKHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-639-0884
Mailing Address - Street 1:11395 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:LYNWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90262-2485
Mailing Address - Country:US
Mailing Address - Phone:310-639-0884
Mailing Address - Fax:310-639-0013
Practice Address - Street 1:11395 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-2485
Practice Address - Country:US
Practice Address - Phone:310-639-0884
Practice Address - Fax:310-639-0013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-25
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46073122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG893997-01OtherDENTI-CAL