Provider Demographics
NPI:1881985216
Name:AKHAVAN, PARHAM
Entity type:Individual
Prefix:
First Name:PARHAM
Middle Name:
Last Name:AKHAVAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31726 RANCHO VIEJO RD STE 103
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-2723
Mailing Address - Country:US
Mailing Address - Phone:949-493-7007
Mailing Address - Fax:
Practice Address - Street 1:31726 RANCHO VIEJO RD STE 103
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-2723
Practice Address - Country:US
Practice Address - Phone:949-493-7007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-19
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28614122300000X
CA60462122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist