| |
24667 Crenshaw Blvd Ste D Torrance CA 90505-5360 | |
(310) 325-8555 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 24667 Crenshaw Blvd Ste D, Torrance, California |
Authorized Official Name and Position | Kayvon Javid (OWNER) |
Authorized Official Contact | 3103258555 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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24667 Crenshaw Blvd Ste D Torrance CA 90505-5360 Ph: (310) 325-8555 | 24667 Crenshaw Blvd Ste D Torrance CA 90505-5360 Ph: (310) 325-8555 |
NPI Number | 1932650322 |
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Provider Enumeration Date | 10/20/2016 |
Last Update Date | 07/01/2022 |
Medicare PECOS PAC ID | 2466830427 |
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Medicare Enrollment ID | O20220602002099 |
Identifier | Type | State | Issuer |
---|---|---|---|
1932650322 | NPI | - | NPPES |
1629413547 | Other | CA | NPI |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1223G0001X | Dentist - General Practice | 48617 (California) | Secondary |
261QS0112X | Clinic/center - Oral And Maxillofacial Surgery | (* (Not Available)) | Primary |
Provider Name | Kayvon Javid |
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Provider Type | Practitioner - Oral Surgery |
Provider Identifiers | NPI Number: 1073697348 PECOS PAC ID: 5294974804 Enrollment ID: I20130611000695 |
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