MEDICARE: DR. PARISH PAYMON SEDGHIZADEH DDS, MS

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	1223P0106X	Oral and Maxillofacial Pathology Dentistry	48677	CA

General Provider Information

NPI Number	:	1760488167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PARISH PAYMON SEDGHIZADEH DDS, MS

Provider Business Mailing Address
First Line	:	925 W 34TH ST
Second Line	:	DEN 4276
City	:	LOS ANGELES
State	:	CA
Zip	:	90089-0641
Country	:	US
Telephone Number	:	213-740-2704
Fax Number	:	213-740-2376

Provider Business Practice Location Address
First Line	:	925 W 34TH ST
Second Line	:	DEN 4276
City	:	LOS ANGELES
State	:	CA
Zip	:	90089-0641
Country	:	US
Telephone Number	:	213-740-2704
Fax Number	:	213-740-2376

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	11/17/2014

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