Healthcare Provider Details

I. General information

NPI: 1205750460
Provider Name (Legal Business Name): MICHAEL NEDJAT-HAIEM DDS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

1901 SOLAR DR STE 185
OXNARD CA
93036-0631
US

IV. Provider business mailing address

200 N SWALL DR UNIT 504
BEVERLY HILLS CA
90211-4725
US

V. Phone/Fax

Practice location:
  • Phone: 310-666-9024
  • Fax:
Mailing address:
  • Phone: 310-666-9024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL NEDJAT-HAIEM
Title or Position: PRESIDENT
Credential: DDS
Phone: 310-666-9024