Provider Demographics
NPI:1407489164
Name:AKHAVAN, MEHRNOOSH (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:MEHRNOOSH
Middle Name:
Last Name:AKHAVAN
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18919 VENTURA BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-3211
Mailing Address - Country:US
Mailing Address - Phone:818-345-9601
Mailing Address - Fax:
Practice Address - Street 1:18919 VENTURA BLVD STE B
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-3211
Practice Address - Country:US
Practice Address - Phone:818-345-9601
Practice Address - Fax:818-757-8901
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-20
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA380201223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics