| Khashayar Khodadadi Dds Inc | |
|
11900 S. Avalon Blvd. Suite 101 Los Angeles CA 90061 | |
| (323) 834-0100 | |
| (323) 834-0101 |
| Full Name | Khashayar Khodadadi Dds Inc |
|---|---|
| Speciality | Dentist |
| Location | 11900 S. Avalon Blvd., Los Angeles, California |
| Authorized Official Name and Position | Khashayar Khodadadi (PRESIDENT) |
| Authorized Official Contact | 3238340100 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Khashayar Khodadadi Dds Inc 11900 S. Avalon Blvd. Suite 101 Los Angeles CA 90061 Ph: (323) 834-0100 | Khashayar Khodadadi Dds Inc 11900 S. Avalon Blvd. Suite 101 Los Angeles CA 90061 Ph: (323) 834-0100 |
| NPI Number | 1003033556 |
|---|---|
| Provider Enumeration Date | 04/19/2007 |
| Last Update Date | 06/14/2010 |
| Medicare PECOS PAC ID | 2668785346 |
|---|---|
| Medicare Enrollment ID | O20150723009523 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003033556 | NPI | - | NPPES |
| G93919-01 | Other | CA | DENTI-CAL PROVIDER NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 43026 (California) | Primary |
| Provider Name | Khashayar Khodadadi |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1083743926 PECOS PAC ID: 6507180759 Enrollment ID: I20150617002165 |
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