Provider Demographics
NPI:1053459065
Name:ABTAHI, HENGAMEH (DDS)
Entity type:Individual
Prefix:
First Name:HENGAMEH
Middle Name:
Last Name:ABTAHI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1508 S BEVERLY GLEN BLVD APT 202
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-6192
Mailing Address - Country:US
Mailing Address - Phone:310-922-2180
Mailing Address - Fax:
Practice Address - Street 1:1508 S BEVERLY GLEN BLVD
Practice Address - Street 2:APT 202
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-6192
Practice Address - Country:US
Practice Address - Phone:310-922-2180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD504301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD50430OtherLICENSE NUMBER