Provider Demographics
NPI:1619449162
Name:NIKJOO DENTAL INC
Entity Type:Organization
Organization Name:NIKJOO DENTAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:EBI
Authorized Official - Middle Name:
Authorized Official - Last Name:NIKJOO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:562-463-3332
Mailing Address - Street 1:14285 AMAR RD
Mailing Address - Street 2:
Mailing Address - City:LA PUENTE
Mailing Address - State:CA
Mailing Address - Zip Code:91746-2154
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14285 AMAR RD
Practice Address - Street 2:
Practice Address - City:LA PUENTE
Practice Address - State:CA
Practice Address - Zip Code:91746-2154
Practice Address - Country:US
Practice Address - Phone:626-917-9308
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NIKJOO DENTAL INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-12-21
Last Update Date:2018-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental