Provider Demographics
NPI:1336385509
Name:REYHANI, HADIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:HADIS
Middle Name:
Last Name:REYHANI
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 1:1155 S LA JOLLA AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-2524
Mailing Address - Country:US
Mailing Address - Phone:310-666-5015
Mailing Address - Fax:213-748-2264
Practice Address - Street 1:1155 S. LA JOLLA AVE.
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-2524
Practice Address - Country:US
Practice Address - Phone:310-666-5015
Practice Address - Fax:213-748-2264
Is Sole Proprietor?:No
Enumeration Date:2008-12-18
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA573731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice