Provider Demographics
NPI:1194802496
Name:AMIN, DAKSHA ARVIND (DDS)
Entity type:Individual
Prefix:MRS
First Name:DAKSHA
Middle Name:ARVIND
Last Name:AMIN
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 1:2670 E GAGE AVE
Mailing Address - Street 2:SUITE #3
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-4176
Mailing Address - Country:US
Mailing Address - Phone:323-581-9486
Mailing Address - Fax:323-581-9476
Practice Address - Street 1:2670 E GAGE AVE
Practice Address - Street 2:SUITE #3
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-4176
Practice Address - Country:US
Practice Address - Phone:323-581-9486
Practice Address - Fax:323-581-9476
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37777122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB3777701Medicaid