Provider Demographics
NPI:1326531658
Name:KAVAND, GOLNAZ
Entity Type:Individual
Prefix:
First Name:GOLNAZ
Middle Name:
Last Name:KAVAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3838 DUNN DR APT 608
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-2776
Mailing Address - Country:US
Mailing Address - Phone:319-400-3949
Mailing Address - Fax:
Practice Address - Street 1:3150 CASE RD BLDG C
Practice Address - Street 2:
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92570-5552
Practice Address - Country:US
Practice Address - Phone:951-345-4386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-12
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1060901223X0400X
OH30.0246401223X0400X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No1223G0001XDental ProvidersDentistGeneral Practice