Provider Demographics
NPI:1093867806
Name:H KAZEMI DDS A PROF COOPERATION
Entity Type:Organization
Organization Name:H KAZEMI DDS A PROF COOPERATION
Other - Org Name:AMERICAN FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:HOSSEIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KAZEMI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:916-789-8530
Mailing Address - Street 1:901 SUNRISE AVE
Mailing Address - Street 2:SUITE A1
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661
Mailing Address - Country:US
Mailing Address - Phone:916-789-8530
Mailing Address - Fax:916-789-1339
Practice Address - Street 1:901 SUNRISE AVE
Practice Address - Street 2:SUITE A1
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661
Practice Address - Country:US
Practice Address - Phone:916-789-8530
Practice Address - Fax:916-789-1339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA468391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty