Provider Demographics
NPI:1598828717
Name:AKHAVAN, TARLAN P (DDS)
Entity Type:Individual
Prefix:DR
First Name:TARLAN
Middle Name:P
Last Name:AKHAVAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 E WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-3723
Mailing Address - Country:US
Mailing Address - Phone:213-222-2990
Mailing Address - Fax:213-222-2972
Practice Address - Street 1:530 E WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-3723
Practice Address - Country:US
Practice Address - Phone:213-222-2990
Practice Address - Fax:213-222-2972
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54323122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist