Provider Demographics
NPI:1467675389
Name:RAHIMI, KIUMARS K (DENTIST)
Entity Type:Individual
Prefix:MR
First Name:KIUMARS
Middle Name:K
Last Name:RAHIMI
Suffix:
Gender:M
Credentials:DENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5010 S LA BREA AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90056-1804
Mailing Address - Country:US
Mailing Address - Phone:323-296-2300
Mailing Address - Fax:323-290-4072
Practice Address - Street 1:5010 S LA BREA AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90056-1804
Practice Address - Country:US
Practice Address - Phone:323-296-2300
Practice Address - Fax:323-290-4072
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA354501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice