Provider Demographics
NPI:1568556025
Name:NAMAZIKHAH, M. SADEGH (DMD, MSED)
Entity Type:Individual
Prefix:DR
First Name:M. SADEGH
Middle Name:
Last Name:NAMAZIKHAH
Suffix:
Gender:M
Credentials:DMD, MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16101 VENTURA BLVD
Mailing Address - Street 2:STE 345
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2500
Mailing Address - Country:US
Mailing Address - Phone:818-789-3236
Mailing Address - Fax:818-789-3228
Practice Address - Street 1:16101 VENTURA BLVD
Practice Address - Street 2:STE 345
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2500
Practice Address - Country:US
Practice Address - Phone:818-789-3236
Practice Address - Fax:818-789-3228
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA313411223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA954535867OtherTAX ID