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General NPI Number Information
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NPI Number | 1801271374
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Entity Type | Organization
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Legal Business Name | DR. FADAEI INC
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Dates
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Enumeration Date | 07/27/2015
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Last Update Date | 07/27/2015
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Provider Practice Location Address
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Address Line | 7335 VAN NUYS BLVD #104
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City | VAN NUYS
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State | CA
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Zip | 91405-1998
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Country | US
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Telephone | 818-787-6787
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Fax | 818-787-2119
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Provider Business Mailing Address
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Address Line | 7335 VAN NUYS BLVD #104
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City | VAN NUYS
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State | CA
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Zip | 91405-1998
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Country | US
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Telephone | 818-787-6787
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Fax | 818-787-2119
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | BEHZAD FADAEI
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Credential | D.D.S
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Telephone | 818-787-6787
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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 | 62751
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License Number State | CA
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