Provider Demographics
NPI:1528578036
Name:KEIVAN SARRAF, DDS, INC
Entity Type:Organization
Organization Name:KEIVAN SARRAF, DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KEIVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SARRAF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-460-9546
Mailing Address - Street 1:1212 BEVERLY VIEW DR
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-2039
Mailing Address - Country:US
Mailing Address - Phone:310-460-9546
Mailing Address - Fax:
Practice Address - Street 1:2630 ZOE AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-4132
Practice Address - Country:US
Practice Address - Phone:323-230-6366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-10
Last Update Date:2017-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty