Provider Demographics
NPI:1699320671
Name:MIZRAHI, YEHONATAN (DDS)
Entity type:Individual
Prefix:
First Name:YEHONATAN
Middle Name:
Last Name:MIZRAHI
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 CORONET DR
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-4325
Mailing Address - Country:US
Mailing Address - Phone:310-595-5584
Mailing Address - Fax:
Practice Address - Street 1:16260 VENTURA BLVD STE 404
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2238
Practice Address - Country:US
Practice Address - Phone:818-986-7411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-06
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104179122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist