Healthcare Provider Details

I. General information

NPI: 1972053361
Provider Name (Legal Business Name): ZAK DDS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2016
Last Update Date: 10/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7319 CLAIREMONT MESA BLVD
SAN DIEGO CA
92111-1101
US

IV. Provider business mailing address

10501 LAKEWOOD BLVD
DOWNEY CA
90241-2709
US

V. Phone/Fax

Practice location:
  • Phone: 858-569-9652
  • Fax:
Mailing address:
  • Phone: 310-503-9277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number38238
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number38238
License Number StateCA

VIII. Authorized Official

Name: DR. ILYA ZAK
Title or Position: DENTIST, CEO
Credential: D.D.S.
Phone: 310-706-5273