Provider Demographics
NPI:1760833545
Name:NOORULLAH AZIM DDS
Entity Type:Organization
Organization Name:NOORULLAH AZIM DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NOORULLAH
Authorized Official - Middle Name:
Authorized Official - Last Name:AZIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-634-3446
Mailing Address - Street 1:3500 LOMITA BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505
Mailing Address - Country:US
Mailing Address - Phone:310-634-3446
Mailing Address - Fax:
Practice Address - Street 1:3500 LOMITA BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-5021
Practice Address - Country:US
Practice Address - Phone:310-634-3446
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-23
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59590305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service