Provider Demographics
NPI:1790238533
Name:SUFIA KAZIMA, FNU
Entity Type:Individual
Prefix:DR
First Name:FNU
Middle Name:
Last Name:SUFIA KAZIMA
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:SUFIA
Other - Middle Name:
Other - Last Name:KAZIMA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:2900 KIRBY RD STE 9
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-8207
Mailing Address - Country:US
Mailing Address - Phone:901-512-7992
Mailing Address - Fax:
Practice Address - Street 1:3068 COVINGTON PIKE STE 2
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38128-5001
Practice Address - Country:US
Practice Address - Phone:901-371-8850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-28
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10352122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist