Provider Demographics
NPI:1780892083
Name:NIKKHAH, JILA (DDS)
Entity type:Individual
Prefix:
First Name:JILA
Middle Name:
Last Name:NIKKHAH
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 1:29 WINDCHIME
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92603-0630
Mailing Address - Country:US
Mailing Address - Phone:949-654-2557
Mailing Address - Fax:
Practice Address - Street 1:1550 SUPERIOR AVE
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-3653
Practice Address - Country:US
Practice Address - Phone:949-650-0186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA453031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice