Healthcare Provider Details

I. General information

NPI: 1891313524
Provider Name (Legal Business Name): ALIREZA KHOSHNOODI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2020
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2827 SAVIERS RD
OXNARD CA
93033-4515
US

IV. Provider business mailing address

2827 SAVIERS RD
OXNARD CA
93033-4515
US

V. Phone/Fax

Practice location:
  • Phone: 310-570-9667
  • Fax:
Mailing address:
  • Phone: 310-570-9667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number42211
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number108650
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: