Provider Demographics
NPI:1578777272
Name:AKHAVAN, MOJDAH MICHELLE (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:MOJDAH
Middle Name:MICHELLE
Last Name:AKHAVAN
Suffix:
Gender:F
Credentials:DDS, MS
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Mailing Address - Street 1:345 F ST
Mailing Address - Street 2:#190
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-2626
Mailing Address - Country:US
Mailing Address - Phone:619-420-5811
Mailing Address - Fax:619-420-5842
Practice Address - Street 1:345 F ST
Practice Address - Street 2:#190
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-2626
Practice Address - Country:US
Practice Address - Phone:619-420-5811
Practice Address - Fax:619-420-5842
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA427961223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics