Healthcare Provider Details

I. General information

NPI: 1245134576
Provider Name (Legal Business Name): LEILI MOLZAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10930 MAGNOLIA BLVD
NORTH HOLLYWOOD CA
91601-3903
US

IV. Provider business mailing address

931 N HOLLYWOOD WAY # 2080
BURBANK CA
91505-2816
US

V. Phone/Fax

Practice location:
  • Phone: 818-616-7817
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN32128
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number42898
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number113759
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: