Healthcare Provider Details

I. General information

NPI: 1598136889
Provider Name (Legal Business Name): NASIBI HEYRANI DDS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2015
Last Update Date: 11/08/2021
Certification Date: 11/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16537 BELLFLOWER BLVD STE B
BELLFLOWER CA
90706-5449
US

IV. Provider business mailing address

16537 BELLFLOWER BLVD STE B
BELLFLOWER CA
90706-5449
US

V. Phone/Fax

Practice location:
  • Phone: 562-867-2026
  • Fax:
Mailing address:
  • Phone: 562-867-2026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number57456
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number60575
License Number StateCA

VIII. Authorized Official

Name: DR. PEJMAN NASIBI
Title or Position: CEO
Credential: DDS
Phone: 310-922-0221