Provider Demographics
NPI:1205590015
Name:E. NIKJOO DDS INC.
Entity type:Organization
Organization Name:E. NIKJOO DDS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EBI
Authorized Official - Middle Name:
Authorized Official - Last Name:NIKJOO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-666-5807
Mailing Address - Street 1:820 W MERCED AVE
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-4901
Mailing Address - Country:US
Mailing Address - Phone:626-918-3388
Mailing Address - Fax:
Practice Address - Street 1:820 W MERCED AVE
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-4901
Practice Address - Country:US
Practice Address - Phone:626-918-3388
Practice Address - Fax:626-918-3359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty