Provider Demographics
NPI:1255631131
Name:ROKHSAR, GHAZAL (DDS)
Entity type:Individual
Prefix:
First Name:GHAZAL
Middle Name:
Last Name:ROKHSAR
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 1:1103 ROSCOMARE RD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90077-2229
Mailing Address - Country:US
Mailing Address - Phone:310-980-5046
Mailing Address - Fax:
Practice Address - Street 1:1723 DURFEE AVE
Practice Address - Street 2:
Practice Address - City:SOUTH EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91733-4557
Practice Address - Country:US
Practice Address - Phone:310-980-5046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-26
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59947122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist