Provider Demographics
NPI:1831358514
Name:KAVEH KANANI DDS INC
Entity type:Organization
Organization Name:KAVEH KANANI DDS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAVEH
Authorized Official - Middle Name:M
Authorized Official - Last Name:KANANI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-999-4445
Mailing Address - Street 1:19634 VENTURA BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-6024
Mailing Address - Country:US
Mailing Address - Phone:818-999-4445
Mailing Address - Fax:818-999-4233
Practice Address - Street 1:19634 VENTURA BLVD STE 100
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-6024
Practice Address - Country:US
Practice Address - Phone:818-999-4445
Practice Address - Fax:818-999-4233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-06
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48128261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1851453518OtherINDIVIDUAL NPI