Provider Demographics
NPI:1871649152
Name:KERMANI, HEDI (DDS, MDS)
Entity type:Individual
Prefix:DR
First Name:HEDI
Middle Name:
Last Name:KERMANI
Suffix:
Gender:F
Credentials:DDS, MDS
Other - Prefix:DR
Other - First Name:HEDIEH
Other - Middle Name:
Other - Last Name:TAVAJOHI-KERMANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS, MDS
Mailing Address - Street 1:2549 EASTBLUFF DR STE B
Mailing Address - Street 2:#415
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-3500
Mailing Address - Country:US
Mailing Address - Phone:949-640-5050
Mailing Address - Fax:949-640-5051
Practice Address - Street 1:14119 PIONEER BLVD
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-3925
Practice Address - Country:US
Practice Address - Phone:562-929-2383
Practice Address - Fax:323-249-7565
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA435651223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD43565Medicaid