Provider Demographics
NPI:1750459723
Name:VAHEDI, HOSSEIN G (DDS)
Entity Type:Individual
Prefix:
First Name:HOSSEIN
Middle Name:G
Last Name:VAHEDI
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 1:1875 S BEVERLY GLEN BLVD APT 401
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-6910
Mailing Address - Country:US
Mailing Address - Phone:310-666-2555
Mailing Address - Fax:
Practice Address - Street 1:1565 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-4233
Practice Address - Country:US
Practice Address - Phone:323-734-8843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA372241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice