Healthcare Provider Details

I. General information

NPI: 1952816118
Provider Name (Legal Business Name): HEJAZI DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2017
Last Update Date: 05/11/2022
Certification Date: 05/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3408 COLLEGE AVE
SAN DIEGO CA
92115-7134
US

IV. Provider business mailing address

PO BOX 920050
DALLAS TX
75392-0050
US

V. Phone/Fax

Practice location:
  • Phone: 619-363-3881
  • Fax: 619-752-1616
Mailing address:
  • Phone: 714-845-8500
  • Fax: 303-952-0892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. ALI HEJAZI
Title or Position: DDS/OWNER
Credential: DMD
Phone: 619-363-3881