Provider Demographics
NPI:1073697348
Name:JAVID, KAYVON (DDS)
Entity Type:Individual
Prefix:DR
First Name:KAYVON
Middle Name:
Last Name:JAVID
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2104 PCH
Mailing Address - Street 2:# 5
Mailing Address - City:LOMITA
Mailing Address - State:CA
Mailing Address - Zip Code:90717-2503
Mailing Address - Country:US
Mailing Address - Phone:310-539-1111
Mailing Address - Fax:310-539-4111
Practice Address - Street 1:2104 PCH #5
Practice Address - Street 2:
Practice Address - City:LOMITA
Practice Address - State:CA
Practice Address - Zip Code:90717-2503
Practice Address - Country:US
Practice Address - Phone:310-539-1111
Practice Address - Fax:310-539-4111
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48617122300000X
CADDS486171223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist