Provider Demographics
NPI:1255486379
Name:GANDJEH, JALEH JASMIN (RDHAP)
Entity Type:Individual
Prefix:MS
First Name:JALEH
Middle Name:JASMIN
Last Name:GANDJEH
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHAP 25124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist