Healthcare Provider Details

I. General information

NPI: 1083867386
Provider Name (Legal Business Name): PEDRAM JOSEPH ZAGHI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2008
Last Update Date: 11/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3551 PECK RD UNIT 101
EL MONTE CA
91731-3527
US

IV. Provider business mailing address

3551 PECK RD UNIT 101
EL MONTE CA
91731-3527
US

V. Phone/Fax

Practice location:
  • Phone: 626-444-2002
  • Fax:
Mailing address:
  • Phone: 626-444-2002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number52698
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: