Healthcare Provider Details

I. General information

NPI: 1932703790
Provider Name (Legal Business Name): DR AZADEH ABRAHAM DENTAL INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2020
Last Update Date: 07/29/2021
Certification Date: 07/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8131 ROSECRANS AVE STE 101
PARAMOUNT CA
90723-2758
US

IV. Provider business mailing address

8131 ROSECRANS AVE STE 101
PARAMOUNT CA
90723-2758
US

V. Phone/Fax

Practice location:
  • Phone: 562-634-2984
  • Fax: 562-634-2986
Mailing address:
  • Phone: 562-634-2984
  • Fax: 562-634-2986

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: DR. AZADEH ABRAHAM
Title or Position: OWNER/DENTIST
Credential:
Phone: 619-846-3830