Provider Demographics
NPI:1750573366
Name:MALEKZADEH, REZA
Entity type:Individual
Prefix:
First Name:REZA
Middle Name:
Last Name:MALEKZADEH
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 1:22627 CAVALIER ST
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-3922
Mailing Address - Country:US
Mailing Address - Phone:818-220-1919
Mailing Address - Fax:
Practice Address - Street 1:15350 NORDHOFF ST
Practice Address - Street 2:SUITE A&B
Practice Address - City:NORTH HILLS
Practice Address - State:CA
Practice Address - Zip Code:91343-2234
Practice Address - Country:US
Practice Address - Phone:818-672-8228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-16
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA548141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice