Provider Demographics
NPI:1629543228
Name:ALBOORZ, LLC
Entity Type:Organization
Organization Name:ALBOORZ, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMAD
Authorized Official - Middle Name:A
Authorized Official - Last Name:YAZDI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, PHD
Authorized Official - Phone:310-401-4300
Mailing Address - Street 1:1500 PASEO DE ORO
Mailing Address - Street 2:
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-1962
Mailing Address - Country:US
Mailing Address - Phone:310-401-4300
Mailing Address - Fax:
Practice Address - Street 1:49 KEENAN ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-2904
Practice Address - Country:US
Practice Address - Phone:310-401-4300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-10
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
No292200000XLaboratoriesDental LaboratoryGroup - Single Specialty