Provider Demographics
NPI:1053455923
Name:ELHAM KHEIRKHAHI DDS MSD INC
Entity type:Organization
Organization Name:ELHAM KHEIRKHAHI DDS MSD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ELHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:KHEIRKHAHI-LOVE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MSD
Authorized Official - Phone:760-836-1809
Mailing Address - Street 1:72780 COUNTRY CLUB DR
Mailing Address - Street 2:SUITE # 402
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-4126
Mailing Address - Country:US
Mailing Address - Phone:760-836-1809
Mailing Address - Fax:760-270-9419
Practice Address - Street 1:72780 COUNTRY CLUB DR
Practice Address - Street 2:SUITE # 402
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-4126
Practice Address - Country:US
Practice Address - Phone:760-836-1809
Practice Address - Fax:760-270-9419
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELHAM KHEIRKHAHI DDS MSD INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-16
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46081122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty