Provider Demographics
NPI:1851714125
Name:NIKZAD NAFISI DENTAL CORP
Entity Type:Organization
Organization Name:NIKZAD NAFISI DENTAL CORP
Other - Org Name:KISS DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARDARELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-750-1582
Mailing Address - Street 1:600 W MANCHESTER AVE
Mailing Address - Street 2:#2
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90044-5770
Mailing Address - Country:US
Mailing Address - Phone:323-750-1582
Mailing Address - Fax:
Practice Address - Street 1:600 W MANCHESTER AVE
Practice Address - Street 2:#2
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90044-5770
Practice Address - Country:US
Practice Address - Phone:323-750-1582
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-22
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61481122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1972855658OtherNPI NUMBER