Provider Demographics
NPI:1568242006
Name:AMIR KAZIM DENTAL
Entity Type:Organization
Organization Name:AMIR KAZIM DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AMIR
Authorized Official - Middle Name:EBRAHIM
Authorized Official - Last Name:KAZIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-335-1249
Mailing Address - Street 1:3395 MICHELSON DR APT 3438
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-4491
Mailing Address - Country:US
Mailing Address - Phone:301-335-1249
Mailing Address - Fax:
Practice Address - Street 1:351 HOSPITAL RD STE 419
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3507
Practice Address - Country:US
Practice Address - Phone:949-548-0505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental