MEDICARE: FAHEEM QAZI DDS CORP

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	50165	OTHER	CA	DENTAL BOARD OF CALIFORNIA
2	1336359405	OTHER		NPI
3	55694	OTHER	CA	DENTAL BOARD OF CALIFORNIA
4	100698	OTHER	CA	DENTAL BOARD OF CALIFORNIA
5	1407300130	OTHER		NPI
6	1497462220	OTHER		NPI

General Provider Information

NPI Number	:	1396466801
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAHEEM QAZI DDS CORP

Provider Business Mailing Address
First Line	:	4456 VIA PINZON
Second Line	:
City	:	PALOS VERDES ESTATES
State	:	CA
Zip	:	90274-1558
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2731 MANHATTAN BEACH BLVD
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90278-1602
Country	:	US
Telephone Number	:	310-683-5322
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. FAHEEM AHMED QAZI
Credential	:	DDS
Telephone Number	:	310-613-3153

Provider Enumeration Date	:	09/05/2022
Last Update Date	:	12/25/2022

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Directions to “FAHEEM QAZI DDS CORP ” Practice Location

Language	Start Address	Practice Location

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