Healthcare Provider Details

I. General information

NPI: 1760488167
Provider Name (Legal Business Name): PARISH PAYMON SEDGHIZADEH DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 11/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 W 34TH ST DEN 4276
LOS ANGELES CA
90089-0641
US

IV. Provider business mailing address

925 W 34TH ST DEN 4276
LOS ANGELES CA
90089-0641
US

V. Phone/Fax

Practice location:
  • Phone: 213-740-2704
  • Fax: 213-740-2376
Mailing address:
  • Phone: 213-740-2704
  • Fax: 213-740-2376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number48677
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: