Provider Demographics
NPI:1912458423
Name:DARA KIMIA DMD A DENTAL CORP
Entity Type:Organization
Organization Name:DARA KIMIA DMD A DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DARA
Authorized Official - Middle Name:
Authorized Official - Last Name:KIMIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-619-1415
Mailing Address - Street 1:16605 DEVONSHIRE ST
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-6631
Mailing Address - Country:US
Mailing Address - Phone:480-619-1415
Mailing Address - Fax:
Practice Address - Street 1:16605 DEVONSHIRE ST
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-6631
Practice Address - Country:US
Practice Address - Phone:480-619-1415
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-19
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA611271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty