Provider Demographics
NPI:1558484535
Name:KAMRAVA, RAMBOD
Entity Type:Individual
Prefix:
First Name:RAMBOD
Middle Name:
Last Name:KAMRAVA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:RAMBOD
Other - Middle Name:
Other - Last Name:KAMRAVA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:5400 BALBOA BLVD
Mailing Address - Street 2:#327
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316
Mailing Address - Country:US
Mailing Address - Phone:818-981-8115
Mailing Address - Fax:
Practice Address - Street 1:5400 BALBOA BLVD
Practice Address - Street 2:#327
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316
Practice Address - Country:US
Practice Address - Phone:818-345-0891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA486191223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics