Provider Demographics
NPI:1083048490
Name:HENDIFAR, ELNAZ
Entity type:Individual
Prefix:
First Name:ELNAZ
Middle Name:
Last Name:HENDIFAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16508 HARTSOOK ST
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-1109
Mailing Address - Country:US
Mailing Address - Phone:818-337-9771
Mailing Address - Fax:
Practice Address - Street 1:16508 HARTSOOK ST
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-1109
Practice Address - Country:US
Practice Address - Phone:818-337-9771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62808122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist