Provider Demographics
NPI:1003211731
Name:MEHRAN JAVAHERIAN
Entity Type:Organization
Organization Name:MEHRAN JAVAHERIAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MEHRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JAVAHERIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-897-1999
Mailing Address - Street 1:9700 WOODMAN AVE
Mailing Address - Street 2:SUITE A29
Mailing Address - City:ARLETA
Mailing Address - State:CA
Mailing Address - Zip Code:91331-6459
Mailing Address - Country:US
Mailing Address - Phone:818-897-1999
Mailing Address - Fax:
Practice Address - Street 1:9700 WOODMAN AVE
Practice Address - Street 2:SUITE A29
Practice Address - City:ARLETA
Practice Address - State:CA
Practice Address - Zip Code:91331-6459
Practice Address - Country:US
Practice Address - Phone:818-897-1999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-23
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA380601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA38060Medicaid