Provider Demographics
NPI:1073794780
Name:DR. EHTERAM BENJI BEHROOZAN
Entity Type:Organization
Organization Name:DR. EHTERAM BENJI BEHROOZAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EHTERAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BENJI BEHROOZAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:323-463-7252
Mailing Address - Street 1:5255 W SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-5716
Mailing Address - Country:US
Mailing Address - Phone:323-463-7252
Mailing Address - Fax:323-463-5622
Practice Address - Street 1:5255 W SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-5716
Practice Address - Country:US
Practice Address - Phone:323-463-7252
Practice Address - Fax:323-463-5622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-21
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31568122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty