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General NPI Number Information
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NPI Number | 1922789528
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Entity Type | Individual
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Provider Name | KHIZER KHURRAM HAFEEZ DDS
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Gender | Male
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Dates
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Enumeration Date | 07/26/2023
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Last Update Date | 10/16/2023
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Provider Practice Location Address
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Address Line | 1600 W REDONDO BEACH BLVD STE 203
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City | GARDENA
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State | CA
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Zip | 90247-3228
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Country | US
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Telephone | 424-321-7470
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Fax |
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Provider Business Mailing Address
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Address Line | 18834 HATTERAS ST UNIT B
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City | TARZANA
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State | CA
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Zip | 91356-1366
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Country | US
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Telephone | 917-470-7998
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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 | 28301
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 109008
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License Number State | CA
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