Provider Demographics
NPI:1073662466
Name:DARYAEI, HOMA (DDS)
Entity Type:Individual
Prefix:DR
First Name:HOMA
Middle Name:
Last Name:DARYAEI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1435 N PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-1656
Mailing Address - Country:US
Mailing Address - Phone:818-243-6091
Mailing Address - Fax:818-243-6091
Practice Address - Street 1:8052 VINELAND AVE STE 109
Practice Address - Street 2:
Practice Address - City:SUN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91352-5513
Practice Address - Country:US
Practice Address - Phone:818-504-2899
Practice Address - Fax:818-504-2899
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2013-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA535891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice