Provider Demographics
NPI:1629413547
Name:JAVID AND NADI DENTAL CORPORATION
Entity Type:Organization
Organization Name:JAVID AND NADI DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KAYVON
Authorized Official - Middle Name:HAKIMI
Authorized Official - Last Name:JAVID
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-539-1111
Mailing Address - Street 1:2104 PACIFIC COAST HWY
Mailing Address - Street 2:
Mailing Address - City:LOMITA
Mailing Address - State:CA
Mailing Address - Zip Code:90717-2584
Mailing Address - Country:US
Mailing Address - Phone:310-539-1111
Mailing Address - Fax:
Practice Address - Street 1:2104 PACIFIC COAST HWY
Practice Address - Street 2:
Practice Address - City:LOMITA
Practice Address - State:CA
Practice Address - Zip Code:90717-2584
Practice Address - Country:US
Practice Address - Phone:310-539-1111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-06
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48617122300000X
261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery
No122300000XDental ProvidersDentistGroup - Single Specialty