Provider Demographics
NPI:1609693654
Name:AHMADI, AVA
Entity type:Individual
Prefix:
First Name:AVA
Middle Name:
Last Name:AHMADI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11750 WILSHIRE BLVD APT 1005
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-6989
Mailing Address - Country:US
Mailing Address - Phone:213-392-5041
Mailing Address - Fax:
Practice Address - Street 1:8393 TOPANGA CANYON BLVD
Practice Address - Street 2:
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91304-2343
Practice Address - Country:US
Practice Address - Phone:818-227-8986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1108061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice