MEDICARE: DR. HESSAM M TAGHIZADEH-TOOSSI 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	1223G0001X	General Practice Dentistry	104152	CA

General Provider Information

NPI Number	:	1184111254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HESSAM M TAGHIZADEH-TOOSSI DDS

Provider Business Mailing Address
First Line	:	7742 REDLANDS ST UNIT D1041
Second Line	:
City	:	PLAYA DEL REY
State	:	CA
Zip	:	90293-7403
Country	:	US
Telephone Number	:	131-035-1774
Fax Number	:

Provider Business Practice Location Address
First Line	:	5029 KANAN RD
Second Line	:
City	:	AGOURA HILLS
State	:	CA
Zip	:	91301-2515
Country	:	US
Telephone Number	:	818-991-9853
Fax Number	:

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

Provider Enumeration Date	:	04/15/2018
Last Update Date	:	12/04/2019

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