Provider Demographics
NPI:1992828347
Name:AKHAMZADEH, SHERVIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHERVIN
Middle Name:
Last Name:AKHAMZADEH
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 1:18221 CLARK ST
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-3601
Mailing Address - Country:US
Mailing Address - Phone:443-802-9634
Mailing Address - Fax:
Practice Address - Street 1:14114 POLK ST
Practice Address - Street 2:
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342-2918
Practice Address - Country:US
Practice Address - Phone:818-364-9444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58030122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist