Provider Demographics
NPI:1861789513
Name:COHEN SEDGH, MANAVI & PAKRAVAN DENTAL CORPORATION
Entity type:Organization
Organization Name:COHEN SEDGH, MANAVI & PAKRAVAN DENTAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FARHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:MANAVI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-820-9933
Mailing Address - Street 1:1835 XIMENO AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-2850
Mailing Address - Country:US
Mailing Address - Phone:310-820-9933
Mailing Address - Fax:310-820-0408
Practice Address - Street 1:1835 XIMENO AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-2850
Practice Address - Country:US
Practice Address - Phone:310-820-9933
Practice Address - Fax:310-820-0408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-01
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38558122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty