Healthcare Provider Details

I. General information

NPI: 1760123525
Provider Name (Legal Business Name): SEDGHIZADEH D.D.S., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 04/05/2022
Certification Date: 04/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9201 W SUNSET BLVD STE 903
WEST HOLLYWOOD CA
90069-3710
US

IV. Provider business mailing address

9201 W SUNSET BLVD STE 903
WEST HOLLYWOOD CA
90069-3710
US

V. Phone/Fax

Practice location:
  • Phone: 424-444-7284
  • Fax: 424-285-6030
Mailing address:
  • Phone: 424-444-7284
  • Fax: 424-285-6030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. PARISH PAYMON SEDGHIZADEH
Title or Position: OWNER
Credential: DDS
Phone: 424-444-7284