Healthcare Provider Details

I. General information

NPI: 1124243928
Provider Name (Legal Business Name): BEHROOZ ZINATI, DDS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8500 WILSHIRE BLVD STE 818
BEVERLY HILLS CA
90211-3106
US

IV. Provider business mailing address

8500 WILSHIRE BLVD STE 818
BEVERLY HILLS CA
90211-3106
US

V. Phone/Fax

Practice location:
  • Phone: 310-652-2010
  • Fax:
Mailing address:
  • Phone: 310-652-2010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number36210
License Number StateCA

VIII. Authorized Official

Name: DR. BEHROOZ ZINATI
Title or Position: PRESIDENT
Credential: DDS
Phone: 310-652-2010