Healthcare Provider Details

I. General information

NPI: 1063643773
Provider Name (Legal Business Name): KORY MICHAEL ZUSSMAN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2009
Last Update Date: 07/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16311 VENTURA BLVD STE 625
ENCINO CA
91436-4317
US

IV. Provider business mailing address

16311 VENTURA BLVD STE 625
ENCINO CA
91436-4317
US

V. Phone/Fax

Practice location:
  • Phone: 818-907-1318
  • Fax:
Mailing address:
  • Phone: 818-907-1318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number36452
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: