1821526419 NPI number — DR ALEXANDER S MORADZADEH DDS INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821526419 NPI number — DR ALEXANDER S MORADZADEH DDS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR ALEXANDER S MORADZADEH DDS INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CRYSTAL DENTAL
Provider Other Organization Name Type Code:
3
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:
1821526419
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2206 S FIGUEROA ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90007-2049
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
213-748-8448
Provider Business Mailing Address Fax Number:
213-749-5569

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2206 S FIGUEROA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90007-2049
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-748-8448
Provider Business Practice Location Address Fax Number:
213-749-5569
Provider Enumeration Date:
05/26/2017

Additional Information

Authorized Official

Authorized Official Last Name:
MORADZADEH
Authorized Official First Name:
ALEXANDER
Authorized Official Middle Name:
S
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
213-748-8448

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  57506 , 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)





Copyright © 2007-2024 www.npivalidator.com