Provider Demographics
NPI:1487333845
Name:GHODS, KAVEH (DDS)
Entity type:Individual
Prefix:
First Name:KAVEH
Middle Name:
Last Name:GHODS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18564 OUTER HWY 18 STE 301
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-2340
Mailing Address - Country:US
Mailing Address - Phone:469-939-4353
Mailing Address - Fax:
Practice Address - Street 1:30 N MADISON AVE UNIT 118
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-1794
Practice Address - Country:US
Practice Address - Phone:469-939-4353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-13
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1063991223P0221X
TX401961223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty