Provider Demographics
NPI:1689857039
Name:KIAI, KAIVAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KAIVAN
Middle Name:
Last Name:KIAI
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 1:17525 VENTURA BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-5100
Mailing Address - Country:US
Mailing Address - Phone:818-784-7832
Mailing Address - Fax:818-784-4789
Practice Address - Street 1:17525 VENTURA BLVD STE 100
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-5100
Practice Address - Country:US
Practice Address - Phone:818-784-7832
Practice Address - Fax:818-784-4789
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-07
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA474921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice