Provider Demographics
NPI:1225805997
Name:FERESHTEH YOUSEFZADEH, DDS, MSD, INC
Entity Type:Organization
Organization Name:FERESHTEH YOUSEFZADEH, DDS, MSD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:FERESHTEH
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUSEFZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:310-795-1319
Mailing Address - Street 1:900 N TIGERTAIL RD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-1419
Mailing Address - Country:US
Mailing Address - Phone:310-795-1319
Mailing Address - Fax:
Practice Address - Street 1:10884 SANTA MONICA BLVD STE 401
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-7639
Practice Address - Country:US
Practice Address - Phone:310-750-4621
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty