Provider Demographics
NPI:1609526599
Name:NIKJOO DDS INC.
Entity Type:Organization
Organization Name:NIKJOO DDS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:EBI
Authorized Official - Middle Name:DONAVAN
Authorized Official - Last Name:NIKJOO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:562-422-9698
Mailing Address - Street 1:1465 ROBMAR DR # 471
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-2323
Mailing Address - Country:US
Mailing Address - Phone:562-904-8000
Mailing Address - Fax:
Practice Address - Street 1:471 STONEWOOD ST # 471
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-3919
Practice Address - Country:US
Practice Address - Phone:562-904-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-24
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental