Provider Demographics
NPI:1598813693
Name:YASHAR-MATIAN, AIDA (DDS,MS)
Entity Type:Individual
Prefix:DR
First Name:AIDA
Middle Name:
Last Name:YASHAR-MATIAN
Suffix:
Gender:F
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18607 VENTURA BLVD
Mailing Address - Street 2:SUITE# 302
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-4159
Mailing Address - Country:US
Mailing Address - Phone:818-345-5546
Mailing Address - Fax:818-345-6326
Practice Address - Street 1:18607 VENTURA BLVD
Practice Address - Street 2:SUITE# 302
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-4159
Practice Address - Country:US
Practice Address - Phone:818-345-5546
Practice Address - Fax:818-345-6326
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA427871223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics