Healthcare Provider Details

I. General information

NPI: 1386723930
Provider Name (Legal Business Name): KAMBIZ D ABADI DMD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 09/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 OVERLAND AVE A
LOS ANGELES CA
90064-3333
US

IV. Provider business mailing address

2500 OVERLAND AVE A
LOS ANGELES CA
90064-3333
US

V. Phone/Fax

Practice location:
  • Phone: 310-202-6040
  • Fax: 310-202-6810
Mailing address:
  • Phone: 310-202-6040
  • Fax: 310-202-6810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number37101
License Number StateCA

VIII. Authorized Official

Name: DR. KAMBIZ DOWLAT ABADI
Title or Position: PRESIDENT
Credential: DMD
Phone: 710-202-6040