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General NPI Number Information
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NPI Number | 1275781692
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Entity Type | Organization
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Legal Business Name | YASAMAN ZADEH D.D.S, INC
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Dates
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Enumeration Date | 08/28/2008
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Last Update Date | 08/28/2008
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Provider Practice Location Address
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Address Line | 10992 ASHTON AVE APT 302
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City | LOS ANGELES
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State | CA
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Zip | 90024-4891
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Country | US
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Telephone | 310-473-8052
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Fax |
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Provider Business Mailing Address
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Address Line | 10992 ASHTON AVE UNIT 302
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City | LOS ANGELES
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State | CA
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Zip | 90024
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Country | US
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Telephone | 310-473-8052
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | YASAMAN HASSANIZADEH
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Credential | D.D.S
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Telephone | 310-430-1444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 57583
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License Number State | CA
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