Healthcare Provider Details

I. General information

NPI: 1194977405
Provider Name (Legal Business Name): NEZAR N DAHDAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2008
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5421 W THUNDERBIRD RD
GLENDALE AZ
85306-4751
US

IV. Provider business mailing address

24002 VIA FABRICANTE STE 201
MISSION VIEJO CA
92691-3931
US

V. Phone/Fax

Practice location:
  • Phone: 480-690-7779
  • Fax:
Mailing address:
  • Phone: 623-200-3746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number250348
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number46720
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number46720
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: