Provider Demographics
NPI:1063725638
Name:PARSA, PEJMAN (DDS , MS)
Entity type:Individual
Prefix:DR
First Name:PEJMAN
Middle Name:
Last Name:PARSA
Suffix:
Gender:M
Credentials:DDS , MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10921 WILSHIRE BLVD STE 1203
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-4005
Mailing Address - Country:US
Mailing Address - Phone:424-369-5160
Mailing Address - Fax:
Practice Address - Street 1:10921 WILSHIRE BLVD STE 1203
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-4005
Practice Address - Country:US
Practice Address - Phone:424-369-5160
Practice Address - Fax:424-232-8458
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA595081223E0200X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No1223G0001XDental ProvidersDentistGeneral Practice