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General NPI Number Information
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NPI Number | 1407302474
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Entity Type | Organization
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Legal Business Name | AZIN HAJIGHOLAM REZAEI DDS INC
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Dates
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Enumeration Date | 08/30/2016
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Last Update Date | 03/27/2017
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Provider Practice Location Address
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Address Line | 1035 FOOTHILL BLVD
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City | LA CANADA FLINTRIDGE
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State | CA
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Zip | 91011-3249
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Country | US
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Telephone | 818-952-6000
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Fax | 818-952-6003
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Provider Business Mailing Address
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Address Line | 1035 FOOTHILL BLVD
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City | LA CANADA
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State | CA
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Zip | 91011-3249
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Country | US
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Telephone | 818-952-6000
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Fax | 818-952-6003
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Authorized Official
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Title or Position | PRESIDENT
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Name | AZIN H REZAEI
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Credential | DDS
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Telephone | 818-952-6000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 56863
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License Number State | CA
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