Provider Demographics
NPI:1497823074
Name:MATIAN, KAMAL (DDS)
Entity Type:Individual
Prefix:DR
First Name:KAMAL
Middle Name:
Last Name:MATIAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18701 SHERMAN WAY STE 1
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-4048
Mailing Address - Country:US
Mailing Address - Phone:818-708-7000
Mailing Address - Fax:
Practice Address - Street 1:18701 SHERMAN WAY STE 1
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-4048
Practice Address - Country:US
Practice Address - Phone:818-708-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA305851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice