Provider Demographics
NPI:1447491865
Name:RAFI, KEVIN (DDS)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:RAFI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21516 VICTORY BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367
Mailing Address - Country:US
Mailing Address - Phone:818-884-2700
Mailing Address - Fax:818-884-2705
Practice Address - Street 1:21516 VICTORY BOULEVARD
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367
Practice Address - Country:US
Practice Address - Phone:818-884-2700
Practice Address - Fax:818-884-2705
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-14
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47552122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist