Provider Demographics
NPI:1407302474
Name:AZIN HAJIGHOLAM REZAEI DDS INC
Entity Type:Organization
Organization Name:AZIN HAJIGHOLAM REZAEI DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AZIN
Authorized Official - Middle Name:H
Authorized Official - Last Name:REZAEI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-952-6000
Mailing Address - Street 1:1035 FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:LA CANADA
Mailing Address - State:CA
Mailing Address - Zip Code:91011-3249
Mailing Address - Country:US
Mailing Address - Phone:818-952-6000
Mailing Address - Fax:818-952-6003
Practice Address - Street 1:1035 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:LA CANADA FLINTRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91011-3249
Practice Address - Country:US
Practice Address - Phone:818-952-6000
Practice Address - Fax:818-952-6003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-30
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56863122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty