Healthcare Provider Details

I. General information

NPI: 1720298094
Provider Name (Legal Business Name): AMIR SAZ D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1104 W REDONDO BEACH BLVD
GARDENA CA
90247-3512
US

IV. Provider business mailing address

1104 W REDONDO BEACH BLVD
GARDENA CA
90247-3512
US

V. Phone/Fax

Practice location:
  • Phone: 310-366-7666
  • Fax:
Mailing address:
  • Phone: 310-366-7666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number36368
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: