Healthcare Provider Details

I. General information

NPI: 1629933809
Provider Name (Legal Business Name): PAYAM HOOSHMAND,DMD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19503 CHRISTINA WAY
CERRITOS CA
90703-7733
US

IV. Provider business mailing address

19503 CHRISTINA WAY
CERRITOS CA
90703-7733
US

V. Phone/Fax

Practice location:
  • Phone: 520-300-0645
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. PAYAM HOOSHMAND
Title or Position: DENTIST
Credential: DMD
Phone: 520-300-0645