Provider Demographics
NPI:1720804768
Name:KHORSAND, RAMESH
Entity type:Individual
Prefix:
First Name:RAMESH
Middle Name:
Last Name:KHORSAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15215 MAGNOLIA BLVD UNIT 126
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-1120
Mailing Address - Country:US
Mailing Address - Phone:818-469-9154
Mailing Address - Fax:
Practice Address - Street 1:15215 MAGNOLIA BLVD UNIT 126
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-1120
Practice Address - Country:US
Practice Address - Phone:818-469-9154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1110581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice