Provider Demographics
NPI:1669995296
Name:DAVOUDI CHEGANI, JOULIANA
Entity type:Individual
Prefix:
First Name:JOULIANA
Middle Name:
Last Name:DAVOUDI CHEGANI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3902 LOS OLIVOS LN
Mailing Address - Street 2:
Mailing Address - City:LA CRESCENTA
Mailing Address - State:CA
Mailing Address - Zip Code:91214-1628
Mailing Address - Country:US
Mailing Address - Phone:818-606-2733
Mailing Address - Fax:
Practice Address - Street 1:702 W BROADWAY
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-1010
Practice Address - Country:US
Practice Address - Phone:818-649-1980
Practice Address - Fax:818-484-4747
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-25
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1016241223G0001X, 1223X2210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X2210XDental ProvidersDentistOrofacial Pain
No1223G0001XDental ProvidersDentistGeneral Practice