Provider Demographics
NPI:1013320597
Name:NOOSHI AKAVAN DDS, MS
Entity Type:Organization
Organization Name:NOOSHI AKAVAN DDS, MS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NOOSHI
Authorized Official - Middle Name:
Authorized Official - Last Name:AKAVAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:818-345-9601
Mailing Address - Street 1:18919 VENTURA BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-3211
Mailing Address - Country:US
Mailing Address - Phone:818-345-9601
Mailing Address - Fax:818-757-8901
Practice Address - Street 1:18919 VENTURA BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-3211
Practice Address - Country:US
Practice Address - Phone:818-345-9601
Practice Address - Fax:818-757-8901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-03
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA380201223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty