MEDICARE: NEDJAT-HAIEM DENTAL CORPORATION

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	1223E0200X	Endodontics

General Provider Information

NPI Number	:	1508609413
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEDJAT-HAIEM DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	200 N SWALL DR UNIT 504
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90211-4725
Country	:	US
Telephone Number	:	310-666-9024
Fax Number	:

Provider Business Practice Location Address
First Line	:	612 E CARSON ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90807-2912
Country	:	US
Telephone Number	:	562-585-3636
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MICHAEL NEDJAT-HAIEM
Credential	:	DDS, M.DENT.SC.
Telephone Number	:	310-666-9024

Provider Enumeration Date	:	06/18/2024
Last Update Date	:	06/18/2024

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