Provider Demographics
NPI:1699266775
Name:AZIN H. KOLAHI DMD INC. A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:AZIN H. KOLAHI DMD INC. A PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FANNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ESPARZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-888-6700
Mailing Address - Street 1:5989 TOPANGA CANYON BLVD
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-3623
Mailing Address - Country:US
Mailing Address - Phone:818-888-6700
Mailing Address - Fax:
Practice Address - Street 1:5989 TOPANGA CANYON BLVD
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-3623
Practice Address - Country:US
Practice Address - Phone:818-888-6700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-23
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty