=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164120481
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NAGHMEH NAVIZADEH, DMD INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/16/2023
-----------------------------------------------------
Last Update Date | 02/16/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10884 SANTA MONICA BLVD STE 401
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90025-7639
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-446-4410
-----------------------------------------------------
Fax | 310-446-7832
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 210 N ROCKINGHAM AVE
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90049-2634
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-709-4129
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | NAGHMEH NAVIZADEH
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 310-709-4129
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------