MEDICARE: FERESHTEH YOUSEFZADEH, DDS, MSD, INC

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry

General Provider Information

NPI Number	:	1225805997
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FERESHTEH YOUSEFZADEH, DDS, MSD, INC

Provider Business Mailing Address
First Line	:	900 N TIGERTAIL RD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90049-1419
Country	:	US
Telephone Number	:	310-795-1319
Fax Number	:

Provider Business Practice Location Address
First Line	:	10884 SANTA MONICA BLVD STE 401
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-7639
Country	:	US
Telephone Number	:	310-750-4621
Fax Number	:

Authorized Official
Title or Position	:	ORTHODONTIST
Name	:	DR. FERESHTEH YOUSEFZADEH
Credential	:	DDS, MSD
Telephone Number	:	310-795-1319

Provider Enumeration Date	:	12/04/2023
Last Update Date	:	12/04/2023

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