Provider Demographics
NPI:1265756027
Name:MOJAB, PAYAM (DDS)
Entity type:Individual
Prefix:
First Name:PAYAM
Middle Name:
Last Name:MOJAB
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2542 E FLORENCE AVE
Mailing Address - Street 2:#A
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-4780
Mailing Address - Country:US
Mailing Address - Phone:323-582-0755
Mailing Address - Fax:323-582-7392
Practice Address - Street 1:2542 E FLORENCE AVE
Practice Address - Street 2:#A
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-4780
Practice Address - Country:US
Practice Address - Phone:323-582-0755
Practice Address - Fax:323-582-7392
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-23
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38334122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG93942-01OtherDENTICAL