Provider Demographics
NPI:1568665909
Name:NAZIRI, PEYMAN (DDS)
Entity Type:Individual
Prefix:
First Name:PEYMAN
Middle Name:
Last Name:NAZIRI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:PEYMAN
Other - Middle Name:
Other - Last Name:NAZIRI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1240 AMHERST AVE APT 301
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-1198
Mailing Address - Country:US
Mailing Address - Phone:310-207-0952
Mailing Address - Fax:
Practice Address - Street 1:1240 AMHERST AVE APT 301
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-1198
Practice Address - Country:US
Practice Address - Phone:310-207-0952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44223122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist