Provider Demographics
NPI:1013638774
Name:NAIMZADEH, BAHARA SAFIA (DDS)
Entity type:Individual
Prefix:
First Name:BAHARA
Middle Name:SAFIA
Last Name:NAIMZADEH
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 1:2435 S SEPULVEDA BLVD APT 2732
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-1866
Mailing Address - Country:US
Mailing Address - Phone:360-224-8692
Mailing Address - Fax:
Practice Address - Street 1:16030 BOTHELL EVERETT HWY STE 280
Practice Address - Street 2:
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-1599
Practice Address - Country:US
Practice Address - Phone:360-224-8692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-09
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1079981223G0001X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies