Provider Demographics
NPI:1669639548
Name:KAKOLI, PAYMAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAYMAN
Middle Name:
Last Name:KAKOLI
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 1:6200 WILSHIRE BLVD
Mailing Address - Street 2:1508
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5801
Mailing Address - Country:US
Mailing Address - Phone:323-938-6137
Mailing Address - Fax:323-938-1336
Practice Address - Street 1:6200 WILSHIRE BLVD
Practice Address - Street 2:STE 1508
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5801
Practice Address - Country:US
Practice Address - Phone:323-938-6137
Practice Address - Fax:323-938-1336
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA561511223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics