1811180839 NPI number — DR. SHIDEH AZIMI D.D.S.

Table of content: DR. SHIDEH AZIMI D.D.S. (NPI 1811180839)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811180839 NPI number — DR. SHIDEH AZIMI D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AZIMI
Provider First Name:
SHIDEH
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.D.S.
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:
1811180839
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/20/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
31161 NIGUEL RD
Provider Second Line Business Mailing Address:
SUITE K
Provider Business Mailing Address City Name:
LAGUNA NIGUEL
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92677-4102
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-443-5000
Provider Business Mailing Address Fax Number:
949-496-5005

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
31161 NIGUEL RD
Provider Second Line Business Practice Location Address:
SUITE K
Provider Business Practice Location Address City Name:
LAGUNA NIGUEL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92677-4102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-443-5000
Provider Business Practice Location Address Fax Number:
949-496-5005
Provider Enumeration Date:
08/22/2007

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: 122300000X , with the licence number:  44455 , 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: 90-0114679 . This is a "TAX I.D." identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com