Provider Demographics
NPI:1518165810
Name:NOJAN TALEBZADEH M.D.,D.M.D. INC.
Entity Type:Organization
Organization Name:NOJAN TALEBZADEH M.D.,D.M.D. INC.
Other - Org Name:SOUTH COUNTY ORAL AND MAXILLOFACIAL SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NOJAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TALEBZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD, DMD, JD
Authorized Official - Phone:619-420-3311
Mailing Address - Street 1:246 F ST
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-2818
Mailing Address - Country:US
Mailing Address - Phone:619-420-3311
Mailing Address - Fax:619-420-6645
Practice Address - Street 1:246 F ST
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-2818
Practice Address - Country:US
Practice Address - Phone:619-420-3311
Practice Address - Fax:619-420-6645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-07
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA420981223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU78879Medicare UPIN