Provider Demographics
NPI:1346613593
Name:HENGAMEH ANARAKI, DDS, INC
Entity Type:Organization
Organization Name:HENGAMEH ANARAKI, DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HENGAMEH
Authorized Official - Middle Name:
Authorized Official - Last Name:ANARAKI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:213-388-5533
Mailing Address - Street 1:244 S OXFORD AVE
Mailing Address - Street 2:SUITE 12
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-5173
Mailing Address - Country:US
Mailing Address - Phone:213-388-5533
Mailing Address - Fax:
Practice Address - Street 1:244 S OXFORD AVE
Practice Address - Street 2:SUITE 12
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-5173
Practice Address - Country:US
Practice Address - Phone:213-388-5533
Practice Address - Fax:213-388-5549
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HENGAMEH ANARAKI, DDS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-11-10
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39365122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1871801852Medicaid