Provider Demographics
NPI:1548519051
Name:AGHAJANI, KOOSHA (DMD)
Entity type:Individual
Prefix:
First Name:KOOSHA
Middle Name:
Last Name:AGHAJANI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 N ORANGE ST
Mailing Address - Street 2:UNIT B411
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-5522
Mailing Address - Country:US
Mailing Address - Phone:818-430-2683
Mailing Address - Fax:
Practice Address - Street 1:321 N ORANGE ST
Practice Address - Street 2:UNIT B411
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-5522
Practice Address - Country:US
Practice Address - Phone:818-430-2683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-30
Last Update Date:2017-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61840122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist