Provider Demographics
NPI:1801827001
Name:REZA, HAMID
Entity Type:Individual
Prefix:
First Name:HAMID
Middle Name:
Last Name:REZA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8540 RESEDA BLVD # 101
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-4628
Mailing Address - Country:US
Mailing Address - Phone:818-701-6667
Mailing Address - Fax:818-701-0418
Practice Address - Street 1:8540 RESEDA BLVD # 101
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-4628
Practice Address - Country:US
Practice Address - Phone:818-701-6667
Practice Address - Fax:818-701-0418
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA413071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB41307-02OtherDENTI-CAL