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NPI Code Detail

MEDICARE: ZAK DENTAL CORP

MEDICARE: ZAK DENTAL CORP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist
21223E0200XEndodontics
31223S0112XOral and Maxillofacial Surgery (Dentist)
41223X0400XOrthodontics and Dentofacial Orthopedics Dentistry

General Provider Information

NPI Number : 1558791079
Entity Type Code : Organization
Provider Name (Legal Business Name) : ZAK DENTAL CORP
Provider Business Mailing Address
First Line : 3620 LONG BEACH BLVD
Second Line : SUITE B6
City : LONG BEACH
State : CA
Zip : 90807-4022
Country : US
Telephone Number : 562-426-6458
Fax Number : 310-734-1546
Provider Business Practice Location Address
First Line : 3620 LONG BEACH BLVD
Second Line : SUITE B6
City : LONG BEACH
State : CA
Zip : 90807-4022
Country : US
Telephone Number : 562-426-6458
Fax Number : 310-734-1546
Authorized Official
Title or Position : DENTIST/OWNER/CEO
Name : DR. ILYA ZAK
Credential : D.D.S.
Telephone Number : 310-706-5273
Provider Enumeration Date : 11/19/2013
Last Update Date : 11/19/2013

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Directions to “ZAK DENTAL CORP ” Practice Location

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