Provider Demographics
NPI:1598425274
Name:NOOSHI AKAVAN DDS A PROFESSIONAL CORP
Entity Type:Organization
Organization Name:NOOSHI AKAVAN DDS A PROFESSIONAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MEHRNOOSH
Authorized Official - Middle Name:
Authorized Official - Last Name:AKHAVAB
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-345-9601
Mailing Address - Street 1:18919 VENTURA BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-3211
Mailing Address - Country:US
Mailing Address - Phone:818-345-9601
Mailing Address - Fax:818-757-8901
Practice Address - Street 1:18919 VENTURA BLVD STE B
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-3211
Practice Address - Country:US
Practice Address - Phone:818-345-9601
Practice Address - Fax:818-757-8901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-22
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty