Healthcare Provider Details

I. General information

NPI: 1306684279
Provider Name (Legal Business Name): ASEMI DDS A PROFESSIONAL DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2024
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 S CATALINA AVE STE A
REDONDO BEACH CA
90277-4795
US

IV. Provider business mailing address

915 S CATALINA AVE STE A
REDONDO BEACH CA
90277-4795
US

V. Phone/Fax

Practice location:
  • Phone: 650-274-6832
  • Fax:
Mailing address:
  • Phone: 650-274-6832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ARIA ASEMI
Title or Position: OWNER/DENTIST
Credential: DDS
Phone: 650-274-6832