Provider Demographics
NPI:1649406638
Name:RAHIMI, RONAN (DMD)
Entity Type:Individual
Prefix:
First Name:RONAN
Middle Name:
Last Name:RAHIMI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1537 S SHENANDOAH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-4480
Mailing Address - Country:US
Mailing Address - Phone:310-735-4356
Mailing Address - Fax:
Practice Address - Street 1:1537 S SHENANDOAH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-4480
Practice Address - Country:US
Practice Address - Phone:310-735-4356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-03
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59163122300000X
NJ22DI02397100122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist