Provider Demographics
NPI:1356543896
Name:KAMALI TAHA, ARASH (DDS)
Entity type:Individual
Prefix:
First Name:ARASH
Middle Name:
Last Name:KAMALI TAHA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5680 LAKE MURRAY BLVD
Mailing Address - Street 2:STE B
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942
Mailing Address - Country:US
Mailing Address - Phone:619-465-3393
Mailing Address - Fax:619-465-3394
Practice Address - Street 1:5680 LAKE MURRAY BLVD
Practice Address - Street 2:STE B
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942
Practice Address - Country:US
Practice Address - Phone:619-465-3393
Practice Address - Fax:619-465-3394
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43175122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist