Provider Demographics
NPI:1780045435
Name:MOAZEMI, LALEH (RDH)
Entity Type:Individual
Prefix:
First Name:LALEH
Middle Name:
Last Name:MOAZEMI
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:248 S REXFORD DR APT 1
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-4025
Mailing Address - Country:US
Mailing Address - Phone:217-766-4391
Mailing Address - Fax:
Practice Address - Street 1:248 S REXFORD DR APT 1
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-4025
Practice Address - Country:US
Practice Address - Phone:217-766-4391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-09
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16494124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist