MEDICARE: NIKZAD NAFISI D.M.D.

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	1223G0001X	General Practice Dentistry	61481	CA
2	122300000X	Dentist	61481	CA

General Provider Information

NPI Number	:	1972855658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIKZAD NAFISI D.M.D.

Provider Business Mailing Address
First Line	:	9190 W OLYMPIC BLVD # 228
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90212-3540
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4521 SHERMAN OAKS AVE STE 2
Second Line	:
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91403-3807
Country	:	US
Telephone Number	:	310-867-5885
Fax Number	:

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

Provider Enumeration Date	:	10/05/2012
Last Update Date	:	03/17/2018

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