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NPI Code Detail

MEDICARE: SOODABEH AZARMI DDS INC

MEDICARE: SOODABEH AZARMI 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
11223G0001XGeneral Practice Dentistry

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1B39938OTHERCADENTI-CAL PROVIDER

General Provider Information

NPI Number : 1801079066
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOODABEH AZARMI DDS INC
Provider Business Mailing Address
First Line : 4310 OVERLAND AVE
Second Line :
City : CULVER CITY
State : CA
Zip : 90230-4117
Country : US
Telephone Number : 310-837-8087
Fax Number : 310-837-8096
Provider Business Practice Location Address
First Line : 4310 OVERLAND AVE
Second Line :
City : CULVER CITY
State : CA
Zip : 90230-4117
Country : US
Telephone Number : 310-837-8087
Fax Number : 310-837-8096
Authorized Official
Title or Position : OWNER
Name : MS. SOODABEH AZARMI
Credential : DDS
Telephone Number : 310-837-8087
Provider Enumeration Date : 12/11/2007
Last Update Date : 12/11/2007

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