Provider Demographics
NPI:1235845660
Name:MAZUMDER, MD ASADUZZAMAN
Entity Type:Individual
Prefix:
First Name:MD
Middle Name:ASADUZZAMAN
Last Name:MAZUMDER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10270 E TARON DR APT 330
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-8234
Mailing Address - Country:US
Mailing Address - Phone:917-463-8784
Mailing Address - Fax:
Practice Address - Street 1:5501 STOCKTON BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95820-5414
Practice Address - Country:US
Practice Address - Phone:916-619-7168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1085261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice