Provider Demographics
NPI:1518585116
Name:NASRIN KHORRAM DENTAL CORP.
Entity Type:Organization
Organization Name:NASRIN KHORRAM DENTAL CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:NASRIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KHORRAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-570-3207
Mailing Address - Street 1:944 BERKELEY ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-2308
Mailing Address - Country:US
Mailing Address - Phone:310-570-3207
Mailing Address - Fax:
Practice Address - Street 1:21914 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-1724
Practice Address - Country:US
Practice Address - Phone:310-570-3207
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-09
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty