Provider Demographics
NPI:1922789528
Name:HAFEEZ, KHIZER KHURRAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:KHIZER
Middle Name:KHURRAM
Last Name:HAFEEZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18834 HATTERAS ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-1366
Mailing Address - Country:US
Mailing Address - Phone:917-470-7998
Mailing Address - Fax:
Practice Address - Street 1:1600 W REDONDO BEACH BLVD STE 203
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-3228
Practice Address - Country:US
Practice Address - Phone:424-321-7470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-26
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL28301122300000X
CA1090081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist