Healthcare Provider Details

I. General information

NPI: 1356193098
Provider Name (Legal Business Name): HELIA NEZHAD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2024
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4030 S WESTERN AVE STE 200
LOS ANGELES CA
90062-1634
US

IV. Provider business mailing address

3302 GASTON AVE
DALLAS TX
75246-2013
US

V. Phone/Fax

Practice location:
  • Phone: 323-248-0965
  • Fax: 323-248-0965
Mailing address:
  • Phone: 214-828-8215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDDS111327
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: