Provider Demographics
NPI:1942526157
Name:FARZADKOHANBASH INC. DBA UNITEDDENTALOFFICE
Entity Type:Organization
Organization Name:FARZADKOHANBASH INC. DBA UNITEDDENTALOFFICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FARZAD
Authorized Official - Middle Name:
Authorized Official - Last Name:KOHANBASH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:323-733-0570
Mailing Address - Street 1:1720 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-5804
Mailing Address - Country:US
Mailing Address - Phone:323-733-0570
Mailing Address - Fax:323-733-0540
Practice Address - Street 1:1720 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-5804
Practice Address - Country:US
Practice Address - Phone:323-733-0570
Practice Address - Fax:323-733-0540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-13
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41441122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1992914675OtherTYPE1 INDIVIDUAL NPI