Provider Demographics
NPI:1043646110
Name:TARLAN P AKHAVAN DDS A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:TARLAN P AKHAVAN DDS A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TARLAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:AKHAVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-801-5054
Mailing Address - Street 1:530 E WASHINGTON BLVD # A
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-3723
Mailing Address - Country:US
Mailing Address - Phone:213-222-2990
Mailing Address - Fax:
Practice Address - Street 1:530 E WASHINGTON BLVD # A
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-3723
Practice Address - Country:US
Practice Address - Phone:213-222-2990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-20
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty