MEDICARE: REZA MALEKZADEH

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	54814	CA

General Provider Information

NPI Number	:	1750573366
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REZA MALEKZADEH

Provider Business Mailing Address
First Line	:	22627 CAVALIER ST
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91364-3922
Country	:	US
Telephone Number	:	818-220-1919
Fax Number	:

Provider Business Practice Location Address
First Line	:	15350 NORDHOFF ST
Second Line	:	SUITE A&B
City	:	NORTH HILLS
State	:	CA
Zip	:	91343-2234
Country	:	US
Telephone Number	:	818-672-8228
Fax Number	:

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

Provider Enumeration Date	:	08/16/2007
Last Update Date	:	08/05/2013

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