Provider Demographics
NPI:1871796219
Name:KAIVAN KIAI DDS INC
Entity type:Organization
Organization Name:KAIVAN KIAI DDS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:BRANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:HIGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-784-7832
Mailing Address - Street 1:17525 VENTURA BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-5100
Mailing Address - Country:US
Mailing Address - Phone:818-784-7832
Mailing Address - Fax:818-784-4789
Practice Address - Street 1:17525 VENTURA BLVD STE 100
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-5100
Practice Address - Country:US
Practice Address - Phone:818-784-7832
Practice Address - Fax:818-784-4789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA474921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty