Provider Demographics
NPI:1508208588
Name:PAJOUHAN, KAVEH (DDS)
Entity Type:Individual
Prefix:
First Name:KAVEH
Middle Name:
Last Name:PAJOUHAN
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 1:4316 MARINA CITY DR UNIT 823
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-5819
Mailing Address - Country:US
Mailing Address - Phone:310-592-4642
Mailing Address - Fax:
Practice Address - Street 1:4316 MARINA CITY DR UNIT 823
Practice Address - Street 2:
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-5819
Practice Address - Country:US
Practice Address - Phone:310-592-4642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-19
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CADDS1006901223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program