Healthcare Provider Details

I. General information

NPI: 1649366899
Provider Name (Legal Business Name): PARISA HEJAZI DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

923 W CARSON ST
TORRANCE CA
90502-2003
US

IV. Provider business mailing address

14370 CULVER DR SUITE A
IRVINE CA
92604-0307
US

V. Phone/Fax

Practice location:
  • Phone: 310-533-1300
  • Fax:
Mailing address:
  • Phone: 949-551-6555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number41086
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: