Provider Demographics
NPI:1407211618
Name:KAMAL MATIAN DDS INC.
Entity Type:Organization
Organization Name:KAMAL MATIAN DDS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTAL BILLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:
Authorized Official - Last Name:DIANATY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-708-1060
Mailing Address - Street 1:18701 SHERMAN WAY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-4045
Mailing Address - Country:US
Mailing Address - Phone:818-708-7000
Mailing Address - Fax:
Practice Address - Street 1:18701 SHERMAN WAY
Practice Address - Street 2:SUITE 1
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-4045
Practice Address - Country:US
Practice Address - Phone:818-708-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-15
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30585122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty