Provider Demographics
NPI:1598804767
Name:DARAIE, KAVEH TOM (DMD)
Entity Type:Individual
Prefix:DR
First Name:KAVEH
Middle Name:TOM
Last Name:DARAIE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5620 WILBUR AVE
Mailing Address - Street 2:#300
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-1351
Mailing Address - Country:US
Mailing Address - Phone:310-616-6816
Mailing Address - Fax:818-849-6129
Practice Address - Street 1:5620 WILBUR AVE
Practice Address - Street 2:#300
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-1351
Practice Address - Country:US
Practice Address - Phone:310-616-6816
Practice Address - Fax:818-849-6129
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA527201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice