Provider Demographics
NPI:1942455902
Name:ZAKHOR, MANSOUR (DDS)
Entity Type:Individual
Prefix:DR
First Name:MANSOUR
Middle Name:
Last Name:ZAKHOR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:MANSOUR
Other - Middle Name:
Other - Last Name:ZAKHOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1700 WESTWOOD BLVD
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-5608
Mailing Address - Country:US
Mailing Address - Phone:310-666-2386
Mailing Address - Fax:
Practice Address - Street 1:1700 WESTWOOD BLVD
Practice Address - Street 2:SUITE 2A
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024
Practice Address - Country:US
Practice Address - Phone:310-666-2386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-18
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA579041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice