Provider Demographics
NPI:1801957485
Name:GHIAI, MOJGAN (DDS)
Entity type:Individual
Prefix:DR
First Name:MOJGAN
Middle Name:
Last Name:GHIAI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:17075 DEVONSHIRE ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-1600
Mailing Address - Country:US
Mailing Address - Phone:818-368-9191
Mailing Address - Fax:818-368-9173
Practice Address - Street 1:17075 DEVONSHIRE ST
Practice Address - Street 2:SUITE 302
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-1600
Practice Address - Country:US
Practice Address - Phone:818-368-9191
Practice Address - Fax:818-368-9173
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA444031223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA44403OtherLIC.
CABG5616997OtherDEA