Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 55349 | CA |
NPI | 1023263548 |
---|---|
Provider Name | Dr. Mehrnoosh Dianati |
First Address | Woodland Hills, CA 91367-1015 |
Second Address | Winnetka, CA 91306-2686 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/11/2008 |
Last Update Date | 04/12/2009 |