Healthcare Provider Details

I. General information

NPI: 1558768358
Provider Name (Legal Business Name): BEHROOZ ZINATI DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2014
Last Update Date: 11/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7607 ATLANTIC AVE.
CUDAHY CA
90201
US

IV. Provider business mailing address

7607 ATLANTIC AVE.
CUDAHY CA
90201
US

V. Phone/Fax

Practice location:
  • Phone: 323-771-7254
  • Fax:
Mailing address:
  • Phone: 323-771-7254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: BEHROOZ ZINATI
Title or Position: DDS/ DENTIST
Credential:
Phone: 323-771-7254