Provider Demographics
NPI:1982781324
Name:ARDJMAND, KAMBIZ (DDS)
Entity Type:Individual
Prefix:DR
First Name:KAMBIZ
Middle Name:
Last Name:ARDJMAND
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:PO BOX 210668
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91921-0668
Mailing Address - Country:US
Mailing Address - Phone:858-692-4118
Mailing Address - Fax:619-282-9409
Practice Address - Street 1:4230 30TH ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92104-1312
Practice Address - Country:US
Practice Address - Phone:619-282-1007
Practice Address - Fax:619-282-9409
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA382481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice