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General NPI Number Information
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NPI Number | 1235845660
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Entity Type | Individual
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Provider Name | MD ASADUZZAMAN MAZUMDER
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Gender | Male
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Dates
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Enumeration Date | 01/30/2023
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Last Update Date | 01/30/2023
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Provider Practice Location Address
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Address Line | 5501 STOCKTON BLVD
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City | SACRAMENTO
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State | CA
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Zip | 95820-5414
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Country | US
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Telephone | 916-619-7168
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Fax |
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Provider Business Mailing Address
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Address Line | 10270 E TARON DR APT 330
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City | ELK GROVE
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State | CA
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Zip | 95757-8234
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Country | US
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Telephone | 917-463-8784
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 108526
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License Number State | CA
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