Healthcare Provider Details

I. General information

NPI: 1346144052
Provider Name (Legal Business Name): SUSSAN CHANGIZI DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4952 E KINGS CANYON RD STE 101
FRESNO CA
93727-3854
US

IV. Provider business mailing address

266 W BLUFF AVE
FRESNO CA
93711-6930
US

V. Phone/Fax

Practice location:
  • Phone: 559-599-5361
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SUSSAN CHANGIZI
Title or Position: DENTIST
Credential:
Phone: 559-274-2761