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General NPI Number Information
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NPI Number | 1891865861
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Entity Type | Individual
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Provider Name | DR. HAMID REZA ABEDI
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Gender | Male
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 03/02/2023
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Provider Practice Location Address
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Address Line | 1384 109TH AVE NE STE 200
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City | BLAINE
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State | MN
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Zip | 55434-4543
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Country | US
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Telephone | 949-230-7692
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Fax | 909-613-0277
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Provider Business Mailing Address
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Address Line | 3141 MICHELSON DR UNIT 1803
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City | IRVINE
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State | CA
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Zip | 92612-5675
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Country | US
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Telephone | 949-230-7692
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Fax | 909-613-0277
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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 | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 43300
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | S179
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | S7-129C
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License Number State | NV
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