Healthcare Provider Details

I. General information

NPI: 1649815697
Provider Name (Legal Business Name): TMJ THERAPY SLEEP SOLUTION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2019
Last Update Date: 11/03/2020
Certification Date: 11/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11633 SAN VICENTE BLVD STE 216
LOS ANGELES CA
90049-6513
US

IV. Provider business mailing address

11633 SAN VICENTE BLVD STE 216
LOS ANGELES CA
90049-6513
US

V. Phone/Fax

Practice location:
  • Phone: 310-826-3399
  • Fax:
Mailing address:
  • Phone: 310-826-3399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: FARSHID ARIZ
Title or Position: OWNER
Credential: DMD
Phone: 818-452-5325