Provider Demographics
NPI:1952442089
Name:POUYAN, MEHRA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MEHRA
Middle Name:
Last Name:POUYAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15720 VENTURA BLVD
Mailing Address - Street 2:SUITE 609
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2914
Mailing Address - Country:US
Mailing Address - Phone:818-385-3500
Mailing Address - Fax:818-788-7303
Practice Address - Street 1:15720 VENTURA BLVD
Practice Address - Street 2:SUITE 609
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-4733
Practice Address - Country:US
Practice Address - Phone:818-385-3500
Practice Address - Fax:818-788-7303
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-10
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV51371223G0001X
CA548251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice