Provider Demographics
NPI:1750420162
Name:NAZIRI, AMAN (DDS)
Entity type:Individual
Prefix:
First Name:AMAN
Middle Name:
Last Name:NAZIRI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:AMAN
Other - Middle Name:
Other - Last Name:NAZIRI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4186 TWEEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTH GATE
Mailing Address - State:CA
Mailing Address - Zip Code:90280
Mailing Address - Country:US
Mailing Address - Phone:323-569-7131
Mailing Address - Fax:323-569-7131
Practice Address - Street 1:4186 TWEEDY BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280
Practice Address - Country:US
Practice Address - Phone:323-569-7131
Practice Address - Fax:323-569-7131
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA388881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB3888801Medicaid