Provider Demographics
NPI:1619184967
Name:KHAJAVI, ELHAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELHAM
Middle Name:
Last Name:KHAJAVI
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 1:14 DEL VENTURA
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-8827
Mailing Address - Country:US
Mailing Address - Phone:949-679-8712
Mailing Address - Fax:949-347-8458
Practice Address - Street 1:26800 CROWN VALLEY PARKWAY
Practice Address - Street 2:SUITE 405
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691
Practice Address - Country:US
Practice Address - Phone:949-347-0807
Practice Address - Fax:949-347-8458
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51086122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist