Provider Demographics
NPI:1104836667
Name:NIKNIA, KAVEH (DDS)
Entity Type:Individual
Prefix:DR
First Name:KAVEH
Middle Name:
Last Name:NIKNIA
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 1:3101 W COAST HIGHWAY
Mailing Address - Street 2:ST 309
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-4034
Mailing Address - Country:US
Mailing Address - Phone:949-650-6111
Mailing Address - Fax:949-650-0391
Practice Address - Street 1:3101 W COAST HIGHWAY
Practice Address - Street 2:ST 309
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-4034
Practice Address - Country:US
Practice Address - Phone:949-650-6111
Practice Address - Fax:949-650-0391
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA481581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice