Healthcare Provider Details

I. General information

NPI: 1316683022
Provider Name (Legal Business Name): NORWALK DENTAL OFFICE OF ALBORZ MEHDIZADEH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2022
Last Update Date: 05/06/2022
Certification Date: 05/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12100 IMPERIAL HWY # 101A
NORWALK CA
90650-3081
US

IV. Provider business mailing address

12100 IMPERIAL HWY # 101A
NORWALK CA
90650-3081
US

V. Phone/Fax

Practice location:
  • Phone: 562-210-8576
  • Fax: 562-210-8601
Mailing address:
  • Phone: 562-210-8576
  • Fax: 562-210-8601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ALBORZ MEHDIZADEH
Title or Position: CEO
Credential: DDS
Phone: 818-913-8097