Healthcare Provider Details

I. General information

NPI: 1184939720
Provider Name (Legal Business Name): NOORULLAH AZIM DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2010
Last Update Date: 04/19/2024
Certification Date: 04/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24837 JEFFERSON AVE STE 206
MURRIETA CA
92562-7720
US

IV. Provider business mailing address

34003 ABBEY RD
TEMECULA CA
92592-5611
US

V. Phone/Fax

Practice location:
  • Phone: 951-577-8090
  • Fax:
Mailing address:
  • Phone: 310-634-3446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number59590
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: