Provider Demographics
NPI:1386224111
Name:ATOOSA NIKAEEN DDS INC.
Entity type:Organization
Organization Name:ATOOSA NIKAEEN DDS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ATOOSA
Authorized Official - Middle Name:
Authorized Official - Last Name:NIKAEEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-444-1113
Mailing Address - Street 1:11620 WILSHIRE BLVD STE 440
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-1779
Mailing Address - Country:US
Mailing Address - Phone:310-444-1113
Mailing Address - Fax:
Practice Address - Street 1:11620 WILSHIRE BLVD STE 440
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-1779
Practice Address - Country:US
Practice Address - Phone:310-444-1113
Practice Address - Fax:310-444-1123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-14
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental