Provider Demographics
NPI:1063105237
Name:KANANI DENTAL CORPORATION
Entity type:Organization
Organization Name:KANANI DENTAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KAVEH
Authorized Official - Middle Name:
Authorized Official - Last Name:KANANI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-710-9067
Mailing Address - Street 1:450 W PALMDALE BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-3104
Mailing Address - Country:US
Mailing Address - Phone:661-265-7397
Mailing Address - Fax:
Practice Address - Street 1:450 W PALMDALE BLVD STE D
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-3104
Practice Address - Country:US
Practice Address - Phone:661-265-7397
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-01
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1851453518Medicaid
CA1023374410Medicaid