Provider Demographics
NPI:1235493586
Name:MOVAFAGH-PAYMAN, HASTEE (DDS)
Entity Type:Individual
Prefix:MRS
First Name:HASTEE
Middle Name:
Last Name:MOVAFAGH-PAYMAN
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 1:2362 WESTWOOD BLVD SUITE #4
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064
Mailing Address - Country:US
Mailing Address - Phone:310-474-2421
Mailing Address - Fax:310-474-2420
Practice Address - Street 1:2362 WESTWOOD BLVD SUITE #4
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064
Practice Address - Country:US
Practice Address - Phone:310-474-2421
Practice Address - Fax:310-474-2420
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-02
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47963122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist