MEDICARE: DR. RYAN NASIMI

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	DDS108093	CA

General Provider Information

NPI Number	:	1538885488
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RYAN NASIMI

Provider Business Mailing Address
First Line	:	11600 WILSHIRE BLVD STE 316
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-1783
Country	:	US
Telephone Number	:	310-444-4977
Fax Number	:	310-444-1878

Provider Business Practice Location Address
First Line	:	11600 WILSHIRE BLVD STE 316
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-1783
Country	:	US
Telephone Number	:	310-444-4977
Fax Number	:	310-444-1878

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

Provider Enumeration Date	:	10/12/2022
Last Update Date	:	06/15/2026

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