Provider Demographics
NPI:1336685858
Name:VICTORY PLAZA DENTAL GROUP DENTAL OFFICE OF FARNAZ KOHAN INC.
Entity Type:Organization
Organization Name:VICTORY PLAZA DENTAL GROUP DENTAL OFFICE OF FARNAZ KOHAN INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:FARNAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:KOHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-927-0726
Mailing Address - Street 1:13065 VICTORY BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-2925
Mailing Address - Country:US
Mailing Address - Phone:818-927-0726
Mailing Address - Fax:
Practice Address - Street 1:13065 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-2925
Practice Address - Country:US
Practice Address - Phone:818-927-0726
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-08
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62906122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty