Provider Demographics
NPI:1902096258
Name:AKHAVAN, PERLINE (DDS)
Entity Type:Individual
Prefix:
First Name:PERLINE
Middle Name:
Last Name:AKHAVAN
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 1:22224 SAN MIGUEL ST.
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364
Mailing Address - Country:US
Mailing Address - Phone:818-274-7090
Mailing Address - Fax:
Practice Address - Street 1:22224 SAN MIGUEL ST
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-3038
Practice Address - Country:US
Practice Address - Phone:818-274-7090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-01
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56003122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist