Provider Demographics
NPI:1861814048
Name:HOMATI&KOLAHI A DENTAL CORPORATION
Entity Type:Organization
Organization Name:HOMATI&KOLAHI A DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:JAVAD
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLAHI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:323-560-6000
Mailing Address - Street 1:8003 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:CUDAHY
Mailing Address - State:CA
Mailing Address - Zip Code:90201-5712
Mailing Address - Country:US
Mailing Address - Phone:323-560-6000
Mailing Address - Fax:323-560-7859
Practice Address - Street 1:8003 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:CUDAHY
Practice Address - State:CA
Practice Address - Zip Code:90201-5712
Practice Address - Country:US
Practice Address - Phone:323-560-6000
Practice Address - Fax:323-560-7859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-07
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35283122300000X
CA33296122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty