Provider Demographics
NPI:1134261738
Name:RAFIEYAN, NAZAFARIN (DDS)
Entity type:Individual
Prefix:
First Name:NAZAFARIN
Middle Name:
Last Name:RAFIEYAN
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 1:4011 VANALDEN AVE # 20
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-5515
Mailing Address - Country:US
Mailing Address - Phone:951-532-4287
Mailing Address - Fax:818-344-2798
Practice Address - Street 1:7738 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:TUJUNGA
Practice Address - State:CA
Practice Address - Zip Code:91042-2121
Practice Address - Country:US
Practice Address - Phone:818-352-8200
Practice Address - Fax:818-293-3535
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA509841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA202462730OtherTIN