Provider Demographics
NPI:1871685164
Name:TALEBZADEH, NOJAN (MD, DMD,JD)
Entity Type:Individual
Prefix:DR
First Name:NOJAN
Middle Name:
Last Name:TALEBZADEH
Suffix:
Gender:M
Credentials:MD, DMD,JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 F ST
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-2818
Mailing Address - Country:US
Mailing Address - Phone:619-420-3311
Mailing Address - Fax:619-420-6645
Practice Address - Street 1:246 F ST
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-2818
Practice Address - Country:US
Practice Address - Phone:619-420-3311
Practice Address - Fax:619-420-6645
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA420981223S0112X
CAA641272082S0099X, 2086S0122X, 2086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU78879Medicare UPIN