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General NPI Number Information
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NPI Number | 1205019072
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Entity Type | Individual
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Provider Name | FERESHTEH YOUSEFZADEH DDS, MSD, INC
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Gender | Female
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Dates
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Enumeration Date | 12/14/2007
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Last Update Date | 12/11/2023
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Provider Practice Location Address
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Address Line | 10884 SANTA MONICA BLVD. #401
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City | LOS ANGELES
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State | CA
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Zip | 90025
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Country | US
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Telephone | 310-750-4621
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Fax |
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Provider Business Mailing Address
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Address Line | 22287 MOULHOLLAN HIGHWAY #145
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City | CALABASAS
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State | CA
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Zip | 91302
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Country | US
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Telephone | 310-750-7621
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 53961
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License Number State | CA
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