Provider Demographics
NPI:1528189669
Name:KAJIAN-FARAJI, MEHRACK (DDS)
Entity Type:Individual
Prefix:DR
First Name:MEHRACK
Middle Name:
Last Name:KAJIAN-FARAJI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8950 VILLA LA JOLLA DR
Mailing Address - Street 2:B-120
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1714
Mailing Address - Country:US
Mailing Address - Phone:858-455-9614
Mailing Address - Fax:858-455-9520
Practice Address - Street 1:8950 VILLA LA JOLLA DR
Practice Address - Street 2:B-120
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1714
Practice Address - Country:US
Practice Address - Phone:858-455-9614
Practice Address - Fax:858-455-9520
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46271122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist