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General NPI Number Information
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NPI Number | 1730492869
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Entity Type | Individual
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Provider Name | ROUZBEH VOSSOUGHI
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Gender | Male
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Dates
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Enumeration Date | 07/18/2010
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Last Update Date | 08/26/2015
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Provider Practice Location Address
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Address Line | 13910 FOOTHILL BLVD STE B
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City | SYLMAR
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State | CA
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Zip | 91342-3014
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Country | US
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Telephone | 310-806-1599
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Fax |
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Provider Business Mailing Address
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Address Line | 1428 N TIGERTAIL RD
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City | LOS ANGELES
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State | CA
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Zip | 90049-1429
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Country | US
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Telephone | 310-806-1599
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 054245-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 56913
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License Number State | CA
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