Healthcare Provider Details

I. General information

NPI: 1891865861
Provider Name (Legal Business Name): DR. HAMID REZA ABEDI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5175 E PACIFIC COAST HWY STE 405
LONG BEACH CA
90804-3313
US

IV. Provider business mailing address

3141 MICHELSON DR UNIT 1803
IRVINE CA
92612-5675
US

V. Phone/Fax

Practice location:
  • Phone: 562-597-8864
  • Fax: 562-597-8402
Mailing address:
  • Phone: 949-230-7692
  • Fax: 909-613-0277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberS7-129C
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number43300
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License NumberS179
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: