Provider Demographics
NPI:1619276961
Name:DOWLATSHAHI, KIAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KIAN
Middle Name:
Last Name:DOWLATSHAHI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11645 WILSHIRE BLVD STE 980
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-6809
Mailing Address - Country:US
Mailing Address - Phone:310-820-0022
Mailing Address - Fax:310-820-4562
Practice Address - Street 1:11645 WILSHIRE BLVD STE 980
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-6809
Practice Address - Country:US
Practice Address - Phone:310-820-0022
Practice Address - Fax:310-820-4562
Is Sole Proprietor?:No
Enumeration Date:2011-03-24
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36147122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist