Provider Demographics
NPI:1568910479
Name:KAJ, PLLC
Entity Type:Organization
Organization Name:KAJ, PLLC
Other - Org Name:ASTRO DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ARHAMSADR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-357-2575
Mailing Address - Street 1:3110 THOMAS AVE
Mailing Address - Street 2:APARTMENT # 339
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-2729
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1515 S BUCKNER BLVD
Practice Address - Street 2:SUITE # 141
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75217-1760
Practice Address - Country:US
Practice Address - Phone:972-786-1734
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-20
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX283911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty