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NPI Code Detail

MEDICARE: ENSIEH MAZAHERI DDS INC

MEDICARE: ENSIEH MAZAHERI DDS 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
1122300000XDentist

General Provider Information

NPI Number : 1528367208
Entity Type Code : Organization
Provider Name (Legal Business Name) : ENSIEH MAZAHERI DDS INC
Provider Business Mailing Address
First Line : 929 N ORANGE GROVE BLVD # B
Second Line :
City : PASADENA
State : CA
Zip : 91103-3354
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 929 N ORANGE GROVE BLVD # B
Second Line :
City : PASADENA
State : CA
Zip : 91103-3354
Country : US
Telephone Number : 626-449-3701
Fax Number :
Authorized Official
Title or Position : CEO
Name : ENSIEH MAZAHERI
Credential :
Telephone Number : 818-378-8054
Provider Enumeration Date : 03/21/2011
Last Update Date : 03/21/2011

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Directions to “ENSIEH MAZAHERI DDS INC ” Practice Location

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