Provider Demographics
NPI:1689919995
Name:COHEN SEDGH, MANAVI & PAKRAVAN DENTAL CORPORATION
Entity Type:Organization
Organization Name:COHEN SEDGH, MANAVI & PAKRAVAN DENTAL CORPORATION
Other - Org Name:WEST COAST DENTAL GROUP OF GAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FARID
Authorized Official - Middle Name:
Authorized Official - Last Name:PAKRAVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-820-9933
Mailing Address - Street 1:1423 E GAGE AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90001-1771
Mailing Address - Country:US
Mailing Address - Phone:323-983-4000
Mailing Address - Fax:323-983-4007
Practice Address - Street 1:1423 E GAGE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90001-1771
Practice Address - Country:US
Practice Address - Phone:323-983-4000
Practice Address - Fax:323-983-4007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-28
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39862122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty