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Licensing details for: 17198

Name: DENTAL GROUP OF BEVERLY HILLS PRACTICE OF KEIHANI DENTAL CORPORATION

License Type: Fictitious Name Permit

Primary Status: Current - Active

Organization Classification: Corporation

Address of Record

8641 WHILSHIRE BLVD., SUITE 125
BEVERLY HILLS CA 90211
LOS ANGELES county
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Practice Location

8641 WHILSHIRE BLVD., SUITE 125
BEVERLY HILLS CA 90211
LOS ANGELES county
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Issuance Date

June 10, 2022

Expiration Date

July 31, 2025

Current Date / Time

June 6, 2025
2:10:40 AM

License Relationships

FNP Owners

License/Registration Role: Fictitious Name Permit

Related Party Role: Owners

Name: KEIHANI, KOUROSH

Address Not Disclosed

FNP Owners

License/Registration Role: Fictitious Name Permit

Related Party Role: Owners

Name: JABAITI, TARIQ

Address Not Disclosed

FNP to DDS or OMS

License/Registration Role: Fictitious Name Permit

Related Party Role: Must hold an active Dental License, or Oral Maxillofacial Surgery Permit

Name: KEIHANI, KOUROSH

License/Registration Type: Dentist License

License Number: 63776 Primary Status: Current - Active

Address :
1730 E Gonzales Rd
OXNARD CA 93036-3701
VENTURA COUNTY

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FNP to DDS or OMS

License/Registration Role: Fictitious Name Permit

Related Party Role: Must hold an active Dental License, or Oral Maxillofacial Surgery Permit

Name: JABAITI, TARIQ

License/Registration Type: Dentist License

License Number: 102526 Primary Status: Current - Active

Address :
16740 Otsego St
ENCINO CA 91436-1030
LOS ANGELES COUNTY

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