Provider Demographics
NPI:1205982295
Name:TABIBZADEH, NAVID
Entity type:Individual
Prefix:
First Name:NAVID
Middle Name:
Last Name:TABIBZADEH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7335 VAN NUYS BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-1998
Mailing Address - Country:US
Mailing Address - Phone:818-780-7555
Mailing Address - Fax:818-780-7575
Practice Address - Street 1:7335 VAN NUYS BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-1998
Practice Address - Country:US
Practice Address - Phone:818-780-7555
Practice Address - Fax:818-780-7575
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51140122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist