Provider Demographics
NPI:1114082138
Name:ZAHEDI, MALAKEH (DDS)
Entity Type:Individual
Prefix:DR
First Name:MALAKEH
Middle Name:
Last Name:ZAHEDI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13202 MYFORD RD
Mailing Address - Street 2:#200
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92782-9165
Mailing Address - Country:US
Mailing Address - Phone:714-389-2925
Mailing Address - Fax:
Practice Address - Street 1:4487 SLAUSON AVE
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90270-2943
Practice Address - Country:US
Practice Address - Phone:323-773-3094
Practice Address - Fax:323-773-6235
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52135122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist