Provider Demographics
NPI:1205026739
Name:JALEH JASMIN GANDJEH, RDHAP, INC.
Entity Type:Organization
Organization Name:JALEH JASMIN GANDJEH, RDHAP, INC.
Other - Org Name:TOOTH FAIRY DENTAL HYGIENE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JALEH
Authorized Official - Middle Name:JASMIN
Authorized Official - Last Name:GANDJEH
Authorized Official - Suffix:
Authorized Official - Credentials:RDHAP
Authorized Official - Phone:818-344-1121
Mailing Address - Street 1:21157 LASSEN ST
Mailing Address - Street 2:UNIT 2
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-6813
Mailing Address - Country:US
Mailing Address - Phone:818-344-1121
Mailing Address - Fax:818-344-1131
Practice Address - Street 1:18210 SHERMAN WAY
Practice Address - Street 2:SUITE 207
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-4554
Practice Address - Country:US
Practice Address - Phone:818-344-1121
Practice Address - Fax:818-344-1131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-31
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty