Provider Demographics
NPI:1679005045
Name:MARJAN MOHAMMADI D.D.S. INC.
Entity type:Organization
Organization Name:MARJAN MOHAMMADI D.D.S. INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARJAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHAMMADI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:323-962-6000
Mailing Address - Street 1:550 N LARCHMONT BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-1318
Mailing Address - Country:US
Mailing Address - Phone:323-962-6000
Mailing Address - Fax:323-962-6002
Practice Address - Street 1:550 N LARCHMONT BLVD STE 103
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-1318
Practice Address - Country:US
Practice Address - Phone:323-962-6000
Practice Address - Fax:323-962-6002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-03
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA499401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty