Provider Demographics
NPI:1922360866
Name:TAJIK, KATAYOUN (DDS MPH)
Entity Type:Individual
Prefix:DR
First Name:KATAYOUN
Middle Name:
Last Name:TAJIK
Suffix:
Gender:F
Credentials:DDS MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CHILDREN'S DENTAL BUILDING
Mailing Address - Street 2:11635 SOUTH ST
Mailing Address - City:ARTESIA
Mailing Address - State:CA
Mailing Address - Zip Code:90701
Mailing Address - Country:US
Mailing Address - Phone:310-435-3453
Mailing Address - Fax:
Practice Address - Street 1:CHILDREN'S DENTAL BUILDING
Practice Address - Street 2:11635 SOUTH ST
Practice Address - City:ARTESIA
Practice Address - State:CA
Practice Address - Zip Code:90701
Practice Address - Country:US
Practice Address - Phone:310-435-3453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-15
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18566861223P0221X
CADDS1001081223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty