Provider Demographics
NPI:1669657664
Name:MARHABI, PEDRAM AZARI (DDS)
Entity Type:Individual
Prefix:
First Name:PEDRAM
Middle Name:AZARI
Last Name:MARHABI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10856 ROSE AVE APT 210
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-5362
Mailing Address - Country:US
Mailing Address - Phone:310-386-5053
Mailing Address - Fax:
Practice Address - Street 1:28212 KELLY JOHNSON PKWY
Practice Address - Street 2:#180
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-5084
Practice Address - Country:US
Practice Address - Phone:310-386-5053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-08
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53244122300000X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist