Provider Demographics
NPI:1255410585
Name:MIZIN, IRINA K (DDS)
Entity type:Individual
Prefix:
First Name:IRINA
Middle Name:K
Last Name:MIZIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:IRINA
Other - Middle Name:KATHERINE
Other - Last Name:MIZIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:11144 PALMS BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034
Mailing Address - Country:US
Mailing Address - Phone:310-390-2228
Mailing Address - Fax:310-391-6398
Practice Address - Street 1:11144 PALMS BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034
Practice Address - Country:US
Practice Address - Phone:310-390-2228
Practice Address - Fax:310-391-6398
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA414831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice