Provider Demographics
NPI:1144480096
Name:H.IMANKHAN,DDS,ADC
Entity type:Organization
Organization Name:H.IMANKHAN,DDS,ADC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HAMID
Authorized Official - Middle Name:REZA
Authorized Official - Last Name:IMANKHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-225-7768
Mailing Address - Street 1:23111 VENTURA BLVD
Mailing Address - Street 2:104
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-1103
Mailing Address - Country:US
Mailing Address - Phone:818-225-7768
Mailing Address - Fax:818-225-1138
Practice Address - Street 1:23111 VENTURA BLVD
Practice Address - Street 2:104
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-1103
Practice Address - Country:US
Practice Address - Phone:818-225-7768
Practice Address - Fax:818-225-1138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-13
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46073122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG92843OtherDENTI-CAL