1184803561 NPI number — NAGHMEH NIKI JAVAHERIAN DDS

Table of content: NAGHMEH NIKI JAVAHERIAN DDS (NPI 1184803561)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184803561 NPI number — NAGHMEH NIKI JAVAHERIAN DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JAVAHERIAN
Provider First Name:
NAGHMEH
Provider Middle Name:
NIKI
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184803561
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/06/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
09/28/2011
NPI Reactivation Date:
08/06/2013

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16661 VENTURA BLVD
Provider Second Line Business Mailing Address:
SUITE #407
Provider Business Mailing Address City Name:
ENCINO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91436-1914
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-997-4528
Provider Business Mailing Address Fax Number:
818-788-2076

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16661 VENTURA BLVD
Provider Second Line Business Practice Location Address:
SUITE #407
Provider Business Practice Location Address City Name:
ENCINO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91436-1914
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-997-4528
Provider Business Practice Location Address Fax Number:
818-788-2076
Provider Enumeration Date:
11/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  42333 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: W11698 . This is a "GROUP ID" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: FHC 70436F . This is a "MEDI-CAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: B42333-01 . This is a "MEDI-CAL PROVIDER NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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