Healthcare Provider Details

I. General information

NPI: 1427771104
Provider Name (Legal Business Name): HIBBA ZIA BAJWA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2022
Last Update Date: 03/31/2023
Certification Date: 03/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3635 N FREEWAY BLVD STE 110
SACRAMENTO CA
95834-2926
US

IV. Provider business mailing address

3685 CATAMOUNT CREEK AVE
LAS VEGAS NV
89141-3311
US

V. Phone/Fax

Practice location:
  • Phone: 916-285-6691
  • Fax:
Mailing address:
  • Phone: 702-978-0626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDDS108595
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7725
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: