Provider Demographics
NPI:1205019072
Name:YOUSEFZADEH, FERESHTEH (DDS, MSD, INC)
Entity Type:Individual
Prefix:DR
First Name:FERESHTEH
Middle Name:
Last Name:YOUSEFZADEH
Suffix:
Gender:F
Credentials:DDS, MSD, INC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22287 MOULHOLLAN HIGHWAY
Mailing Address - Street 2:#145
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302
Mailing Address - Country:US
Mailing Address - Phone:310-750-7621
Mailing Address - Fax:
Practice Address - Street 1:10884 SANTA MONICA BLVD. #401
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025
Practice Address - Country:US
Practice Address - Phone:310-750-4621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-14
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA539611223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics