Provider Demographics
NPI:1548490410
Name:KOHANZADEH, YORAM (DDS)
Entity type:Individual
Prefix:DR
First Name:YORAM
Middle Name:
Last Name:KOHANZADEH
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 1:2024 SAN YSIDRO DR
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-1537
Mailing Address - Country:US
Mailing Address - Phone:310-786-7868
Mailing Address - Fax:310-786-7836
Practice Address - Street 1:2024 SAN YSIDRO DR
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-1537
Practice Address - Country:US
Practice Address - Phone:310-786-7868
Practice Address - Fax:310-786-7836
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-24
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA582771223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics