Healthcare Provider Details

I. General information

NPI: 1497306070
Provider Name (Legal Business Name): SHERMINEH ZADEH DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2019
Last Update Date: 10/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16133 VENTURA BLVD STE 445
ENCINO CA
91436-2429
US

IV. Provider business mailing address

16133 VENTURA BLVD STE 445
ENCINO CA
91436-2429
US

V. Phone/Fax

Practice location:
  • Phone: 818-918-6070
  • Fax: 818-457-5539
Mailing address:
  • Phone: 818-918-6070
  • 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 Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: SHERMINEH ZADEH
Title or Position: PRESIDENT
Credential: DDS
Phone: 818-918-6070