Provider Demographics
NPI:1003993882
Name:KHODAI, NEDA COURTNEY (DDS)
Entity type:Individual
Prefix:DR
First Name:NEDA
Middle Name:COURTNEY
Last Name:KHODAI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 CORPORATE PARK STE 220
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-3130
Mailing Address - Country:US
Mailing Address - Phone:949-553-1111
Mailing Address - Fax:
Practice Address - Street 1:62 CORPORATE PARK STE 220
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92606-3130
Practice Address - Country:US
Practice Address - Phone:949-553-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA462741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice