Healthcare Provider Details

I. General information

NPI: 1689506883
Provider Name (Legal Business Name): HAYDER ALI KADHIM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 W ADAMS BLVD # 4090A
LOS ANGELES CA
90007-2659
US

IV. Provider business mailing address

325 W ADAMS BLVD
LOS ANGELES CA
90007-2659
US

V. Phone/Fax

Practice location:
  • Phone: 313-529-8751
  • Fax:
Mailing address:
  • Phone: 313-529-8751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number112981
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: