Provider Demographics
NPI:1215229802
Name:FARHAD KIANI DDS PC
Entity Type:Organization
Organization Name:FARHAD KIANI DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FARHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:KIANI FALAVARJANI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-717-6656
Mailing Address - Street 1:12120 INDUSTRY BLVD
Mailing Address - Street 2:SUITE 35
Mailing Address - City:JACKSON
Mailing Address - State:CA
Mailing Address - Zip Code:95642-9374
Mailing Address - Country:US
Mailing Address - Phone:310-717-6656
Mailing Address - Fax:
Practice Address - Street 1:12120 INDUSTRY BLVD
Practice Address - Street 2:SUITE 35
Practice Address - City:JACKSON
Practice Address - State:CA
Practice Address - Zip Code:95642-9374
Practice Address - Country:US
Practice Address - Phone:310-717-6656
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-14
Last Update Date:2011-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty