Provider Demographics
NPI:1528235223
Name:SOHEIL KHODADADI DMD DDS INC
Entity type:Organization
Organization Name:SOHEIL KHODADADI DMD DDS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SOHEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:KHODADADI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, DDS
Authorized Official - Phone:310-271-3003
Mailing Address - Street 1:250 N ROBERTSON BLVD
Mailing Address - Street 2:SUITE 412
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-1788
Mailing Address - Country:US
Mailing Address - Phone:310-271-3003
Mailing Address - Fax:310-271-6299
Practice Address - Street 1:250 N ROBERTSON BLVD
Practice Address - Street 2:SUITE 412
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-1788
Practice Address - Country:US
Practice Address - Phone:310-271-3003
Practice Address - Fax:310-271-6299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1710042478OtherNPI NUMBER