Healthcare Provider Details

I. General information

NPI: 1447320338
Provider Name (Legal Business Name): SHAHRZAD ZARRINNAM D.D.S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8035 W. MANCHESTER AVE. STE. B
PLAYA DEL REY CA
90293
US

IV. Provider business mailing address

8035 W. MANCHESTER AVE. STE. B
PLAYA DEL REY CA
90293
US

V. Phone/Fax

Practice location:
  • Phone: 310-822-8118
  • Fax: 310-821-9276
Mailing address:
  • Phone: 310-822-8118
  • Fax: 310-821-9276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number41913
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: