MEDICARE: NAVID AZIZI DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	109269	CA

General Provider Information

NPI Number	:	1104606425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NAVID AZIZI DDS

Provider Business Mailing Address
First Line	:	1401 3RD ST
Second Line	:
City	:	GILROY
State	:	CA
Zip	:	95020-4753
Country	:	US
Telephone Number	:	408-402-2489
Fax Number	:

Provider Business Practice Location Address
First Line	:	3031 W MARCH LN STE 328
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95219-6562
Country	:	US
Telephone Number	:	408-402-2489
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2023
Last Update Date	:	10/03/2023

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