Provider Demographics
NPI:1124357397
Name:KEIKHAN & FAHID, A DENTAL CORPORATION
Entity type:Organization
Organization Name:KEIKHAN & FAHID, A DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KOUROSH
Authorized Official - Middle Name:
Authorized Official - Last Name:KEIKHANZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MDSC
Authorized Official - Phone:661-222-7267
Mailing Address - Street 1:25880 TOURNAMENT RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-2349
Mailing Address - Country:US
Mailing Address - Phone:661-222-7267
Mailing Address - Fax:661-222-7269
Practice Address - Street 1:25880 TOURNAMENT RD
Practice Address - Street 2:SUITE 106
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-2349
Practice Address - Country:US
Practice Address - Phone:661-222-7267
Practice Address - Fax:661-222-7269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-16
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA538061223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty