Provider Demographics
NPI:1891812533
Name:ZAKI, WEDAD T (DDS)
Entity Type:Individual
Prefix:DR
First Name:WEDAD
Middle Name:T
Last Name:ZAKI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 N SLOPE LN
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91766-4936
Mailing Address - Country:US
Mailing Address - Phone:626-960-9440
Mailing Address - Fax:626-960-5772
Practice Address - Street 1:14314 RAMONA BLVD
Practice Address - Street 2:
Practice Address - City:BALDWIN PARK
Practice Address - State:CA
Practice Address - Zip Code:91706-3241
Practice Address - Country:US
Practice Address - Phone:626-960-9440
Practice Address - Fax:626-960-5772
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA320001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC2134014OtherCALIFORNIA DL #
CA32000OtherPROFESSIONAL LIC #
CAD32000OtherDENTICAL PROVIDER #