Provider Demographics
NPI:1972181964
Name:RODEF & KOHAN DENTAL OFFICE OF VAN NUYS INC
Entity Type:Organization
Organization Name:RODEF & KOHAN DENTAL OFFICE OF VAN NUYS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DDS
Authorized Official - Prefix:
Authorized Official - First Name:FARIBORZ
Authorized Official - Middle Name:
Authorized Official - Last Name:RODEF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-412-0200
Mailing Address - Street 1:2233 E GARVEY AVE N # N
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91791-1500
Mailing Address - Country:US
Mailing Address - Phone:626-412-0200
Mailing Address - Fax:
Practice Address - Street 1:6822 VAN NUYS BLVD
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-4625
Practice Address - Country:US
Practice Address - Phone:626-412-0200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-31
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty