Provider Demographics
NPI:1265139075
Name:ALHEZAIMI, KHALID (BDS)
Entity type:Individual
Prefix:
First Name:KHALID
Middle Name:
Last Name:ALHEZAIMI
Suffix:
Gender:M
Credentials:BDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 W 34TH ST STE 401
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90089-3603
Mailing Address - Country:US
Mailing Address - Phone:213-740-2012
Mailing Address - Fax:
Practice Address - Street 1:1031 W 34TH ST STE 401
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90089-3603
Practice Address - Country:US
Practice Address - Phone:213-740-2012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP3021223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics