Healthcare Provider Details

I. General information

NPI: 1699830729
Provider Name (Legal Business Name): HOMAYOUN ZADEH DDS PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 07/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 RALSTON ST #306
VENTURA CA
93003
US

IV. Provider business mailing address

5700 RALSTON ST #306
VENTURA CA
93003
US

V. Phone/Fax

Practice location:
  • Phone: 805-644-5284
  • Fax:
Mailing address:
  • Phone: 805-644-5284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number35503
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: