Provider Demographics
NPI:1184803561
Name:JAVAHERIAN, NAGHMEH NIKI (DDS)
Entity type:Individual
Prefix:
First Name:NAGHMEH
Middle Name:NIKI
Last Name:JAVAHERIAN
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 1:16661 VENTURA BLVD
Mailing Address - Street 2:SUITE #407
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-1914
Mailing Address - Country:US
Mailing Address - Phone:818-997-4528
Mailing Address - Fax:818-788-2076
Practice Address - Street 1:16661 VENTURA BLVD
Practice Address - Street 2:SUITE #407
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-1914
Practice Address - Country:US
Practice Address - Phone:818-997-4528
Practice Address - Fax:818-788-2076
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-01
Last Update Date:2013-08-06
Deactivation Date:2011-09-28
Deactivation Code:
Reactivation Date:2013-08-06
Provider Licenses
StateLicense IDTaxonomies
CA423331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW11698OtherGROUP ID
CAFHC 70436FOtherMEDI-CAL
CAB42333-01OtherMEDI-CAL PROVIDER NUMBER