Healthcare Provider Details

I. General information

NPI: 1972434579
Provider Name (Legal Business Name): LUBNA AZEEM DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2026
Last Update Date: 05/25/2026
Certification Date: 05/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39200 LIBERTY ST STE C
FREMONT CA
94538-1515
US

IV. Provider business mailing address

39200 LIBERTY ST STE C
FREMONT CA
94538-1515
US

V. Phone/Fax

Practice location:
  • Phone: 510-440-1406
  • Fax:
Mailing address:
  • Phone: 510-440-1406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: LUBNA AZEEM
Title or Position: OWNER/PROVIDER
Credential:
Phone: 510-440-1406