Provider Demographics
NPI:1730107301
Name:RAFIE, KAMRAN (DDS)
Entity type:Individual
Prefix:
First Name:KAMRAN
Middle Name:
Last Name:RAFIE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17656 CHATSWORTH ST
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-5601
Mailing Address - Country:US
Mailing Address - Phone:818-363-0200
Mailing Address - Fax:310-861-8882
Practice Address - Street 1:21150 HAWTHORNE BLVD STE 101
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4617
Practice Address - Country:US
Practice Address - Phone:310-371-0777
Practice Address - Fax:310-861-8882
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA402981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice