Provider Demographics
NPI:1952509754
Name:YAZDI, MEHRAN H (DMD, MPH)
Entity Type:Individual
Prefix:DR
First Name:MEHRAN
Middle Name:H
Last Name:YAZDI
Suffix:
Gender:M
Credentials:DMD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1931 GLENDON AVE
Mailing Address - Street 2:#201
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-4603
Mailing Address - Country:US
Mailing Address - Phone:310-710-0748
Mailing Address - Fax:
Practice Address - Street 1:7201 PAINTER AVE
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90602-1451
Practice Address - Country:US
Practice Address - Phone:310-710-0748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA571211223E0200X, 122300000X
NY0544801223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist