Diana Broumandi, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

47046 Issued in CA

Practice address

11645 Wilshire Blvd.
#745
Los Angeles, CA 90025

Phone

(310) 696-0100

Fax

(310) 395-2288

NPI assigned

May 14, 2007

Last updated

Jun 29, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179100800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624924800000",
    "number": "1194931618",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11645 WILSHIRE BLVD.",
            "address_2": "#745",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "90025",
            "telephone_number": "310-696-0100",
            "fax_number": "310-696-0700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11645 WILSHIRE BLVD.",
            "address_2": "#745",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "90025",
            "telephone_number": "310-696-0100",
            "fax_number": "310-395-2288"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROUMANDI",
        "first_name": "DIANA",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-14",
        "last_updated": "2021-06-29",
        "certification_date": "2021-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "47046",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Lee Brougher, RTC, CTRS
• Xyhaer Broughton
• Marie Brouhard
• Leah Broukhim, AMFT
• Mahnaz Broukhim, MD
• Kimberly Brounstein, MA, AMFT
• Josiah Neal Broussard
• David Allan Brousseau, MD
• Karen Broutvaien
• Janet Louise Browder

• General Practice Dentistry in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.