Provider Demographics
NPI:1710386909
Name:BABAK KOHANOFF D.D.S
Entity Type:Organization
Organization Name:BABAK KOHANOFF D.D.S
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:BABAK
Authorized Official - Middle Name:
Authorized Official - Last Name:KOHANOFF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-349-9151
Mailing Address - Street 1:18250 ROSCOE BLVD
Mailing Address - Street 2:SUITE 225
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-4226
Mailing Address - Country:US
Mailing Address - Phone:818-349-9151
Mailing Address - Fax:818-349-9170
Practice Address - Street 1:18250 ROSCOE BLVD
Practice Address - Street 2:SUITE 225
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-4226
Practice Address - Country:US
Practice Address - Phone:818-349-9151
Practice Address - Fax:818-349-9170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37850122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty