1457795544 NPI number — SHAHENAZ KAMAL AHMED DDS

Table of content: SHAHENAZ KAMAL AHMED DDS (NPI 1457795544)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457795544 NPI number — SHAHENAZ KAMAL AHMED DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AHMED
Provider First Name:
SHAHENAZ
Provider Middle Name:
KAMAL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457795544
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/15/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 9325
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHITTIER
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90608
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
562-789-8515
Provider Business Mailing Address Fax Number:
562-789-8505

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14350 WHITTIER BLVD
Provider Second Line Business Practice Location Address:
ST 210
Provider Business Practice Location Address City Name:
WHITTIER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90605-2103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-789-8515
Provider Business Practice Location Address Fax Number:
562-789-8505
Provider Enumeration Date:
04/19/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  42512 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1669576955 . This is a "WITH CORPORATION" identifier . This identifiers is of the category "OTHER".




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