MEDICARE: NAZAFARIN RAFIEYAN D.D.S.

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	1223G0001X	General Practice Dentistry	50984	CA

General Provider Information

NPI Number	:	1134261738
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NAZAFARIN RAFIEYAN D.D.S.

Provider Business Mailing Address
First Line	:	4011 VANALDEN AVE # 20
Second Line	:
City	:	TARZANA
State	:	CA
Zip	:	91356-5515
Country	:	US
Telephone Number	:	951-532-4287
Fax Number	:	818-344-2798

Provider Business Practice Location Address
First Line	:	7738 FOOTHILL BLVD
Second Line	:
City	:	TUJUNGA
State	:	CA
Zip	:	91042-2121
Country	:	US
Telephone Number	:	818-352-8200
Fax Number	:	818-293-3535

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

Provider Enumeration Date	:	02/12/2007
Last Update Date	:	09/28/2020

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