Healthcare Provider Details

I. General information

NPI: 1073885265
Provider Name (Legal Business Name): LEILA ZAHEDI D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2012
Last Update Date: 02/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 BRYANT ST APT.3
SAN FRANCISCO CA
94107-3601
US

IV. Provider business mailing address

415 BRYANT ST APT.3
SAN FRANCISCO CA
94107-3601
US

V. Phone/Fax

Practice location:
  • Phone: 917-710-3305
  • Fax: 973-556-1269
Mailing address:
  • Phone: 917-710-3305
  • Fax: 973-556-1269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number60384
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: