Provider Demographics
NPI:1063082097
Name:ASEMI, ARIA ALI
Entity type:Individual
Prefix:
First Name:ARIA
Middle Name:ALI
Last Name:ASEMI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ARIA
Other - Middle Name:ALI
Other - Last Name:ASSEMI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1035 W HUNTINGTON DR
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-6536
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:915 S CATALINA AVE STE A
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-4795
Practice Address - Country:US
Practice Address - Phone:310-540-8787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-30
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106332122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist