Provider Demographics
NPI:1356686679
Name:COHEN SEDGH, MANAVI & PAKRAVAN DENTAL CORPORATION
Entity Type:Organization
Organization Name:COHEN SEDGH, MANAVI & PAKRAVAN DENTAL CORPORATION
Other - Org Name:WEST COAST DENTAL GROUP OF BALDWIN PARK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FARHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:MANAVI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-820-9933
Mailing Address - Street 1:4000 LA RICA AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:BALDWIN PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91706-3163
Mailing Address - Country:US
Mailing Address - Phone:626-430-9171
Mailing Address - Fax:626-430-9177
Practice Address - Street 1:4000 LA RICA AVE
Practice Address - Street 2:SUITE D
Practice Address - City:BALDWIN PARK
Practice Address - State:CA
Practice Address - Zip Code:91706-3163
Practice Address - Country:US
Practice Address - Phone:626-430-9171
Practice Address - Fax:626-430-9177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-28
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38558122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty