Provider Demographics
NPI:1295984805
Name:KHAVARAN, SIMA (DDS)
Entity type:Individual
Prefix:DR
First Name:SIMA
Middle Name:
Last Name:KHAVARAN
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 1:127 N LANG AVE
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-2122
Mailing Address - Country:US
Mailing Address - Phone:626-722-5269
Mailing Address - Fax:626-722-5268
Practice Address - Street 1:127 N LANG AVE
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-2122
Practice Address - Country:US
Practice Address - Phone:626-722-5269
Practice Address - Fax:626-722-5268
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-18
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA538101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice