Healthcare Provider Details

I. General information

NPI: 1912727850
Provider Name (Legal Business Name): REZA MALEKZADEH DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2024
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 LONG BEACH BLVD STE 415
LONG BEACH CA
90807-2017
US

IV. Provider business mailing address

4300 LONG BEACH BLVD STE 415
LONG BEACH CA
90807-2017
US

V. Phone/Fax

Practice location:
  • Phone: 562-423-0800
  • Fax:
Mailing address:
  • Phone: 562-423-0800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: REZA MALEKZADEH
Title or Position: OWNER/DENTIST
Credential: DDS
Phone: 562-423-0800