Healthcare Provider Details

I. General information

NPI: 1760833545
Provider Name (Legal Business Name): NOORULLAH AZIM DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2016
Last Update Date: 06/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 LOMITA BLVD SUITE 201
TORRANCE CA
90505-5021
US

IV. Provider business mailing address

3500 LOMITA BLVD SUITE 201
TORRANCE CA
90505
US

V. Phone/Fax

Practice location:
  • Phone: 310-634-3446
  • Fax:
Mailing address:
  • Phone: 310-634-3446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number59590
License Number StateCA

VIII. Authorized Official

Name: DR. NOORULLAH AZIM
Title or Position: PRESIDENT
Credential: DDS
Phone: 310-634-3446