MEDICARE: MALAKEH ZAHEDI DDS INC.

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
1	122300000X	Dentist	52135	CA

General Provider Information

NPI Number	:	1689018483
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MALAKEH ZAHEDI DDS INC.

Provider Business Mailing Address
First Line	:	722 E ARROW HWY
Second Line	:
City	:	POMONA
State	:	CA
Zip	:	91767-2247
Country	:	US
Telephone Number	:	909-621-9177
Fax Number	:	909-621-1561

Provider Business Practice Location Address
First Line	:	722 E ARROW HWY
Second Line	:
City	:	POMONA
State	:	CA
Zip	:	91767-2247
Country	:	US
Telephone Number	:	909-621-9177
Fax Number	:	909-621-1561

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MR. FEREIDOON JAHANGIRI
Credential	:
Telephone Number	:	909-621-9177

Provider Enumeration Date	:	04/23/2013
Last Update Date	:	04/23/2013

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