Provider Demographics
NPI:1538508254
Name:GHAEM-MAGHAMI, NIKI (DDS)
Entity Type:Individual
Prefix:DR
First Name:NIKI
Middle Name:
Last Name:GHAEM-MAGHAMI
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 1:3950 VIA DOLCE APT 509
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-5252
Mailing Address - Country:US
Mailing Address - Phone:310-994-6268
Mailing Address - Fax:310-574-6116
Practice Address - Street 1:3950 VIA DOLCE APT 509
Practice Address - Street 2:
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-5252
Practice Address - Country:US
Practice Address - Phone:310-994-6268
Practice Address - Fax:310-574-6116
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-15
Last Update Date:2013-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49100122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist