Provider Demographics
NPI:1790164960
Name:DR. KHAKSHOOY & DR. VAHEDI DENTAL, INC.
Entity Type:Organization
Organization Name:DR. KHAKSHOOY & DR. VAHEDI DENTAL, INC.
Other - Org Name:SALUD DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SIAMAK
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAKSHOOY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-925-9991
Mailing Address - Street 1:2621 EAST FIRST STREET
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033
Mailing Address - Country:US
Mailing Address - Phone:323-268-9386
Mailing Address - Fax:323-268-9524
Practice Address - Street 1:2621 EAST FIRST STREET
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033
Practice Address - Country:US
Practice Address - Phone:323-268-9386
Practice Address - Fax:323-268-9386
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VAHEDI & KHAKSHOOY DENTAL INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-05-21
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA547351223G0001X
CA545391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty