Provider Demographics
NPI:1245242742
Name:SIMON, ZIV (DMD)
Entity Type:Individual
Prefix:DR
First Name:ZIV
Middle Name:
Last Name:SIMON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1607 GLENDON AVE APT 6
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-6839
Mailing Address - Country:US
Mailing Address - Phone:310-470-8770
Mailing Address - Fax:310-470-8770
Practice Address - Street 1:9400 BRIGHTON WAY STE 311
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4710
Practice Address - Country:US
Practice Address - Phone:310-273-1900
Practice Address - Fax:310-247-2332
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA509881223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics