Provider Demographics
NPI:1063882504
Name:KAZIM, AMIR EBRAHIM (DDS)
Entity type:Individual
Prefix:DR
First Name:AMIR
Middle Name:EBRAHIM
Last Name:KAZIM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 W OCEAN BLVD APT 1606
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-7945
Mailing Address - Country:US
Mailing Address - Phone:301-335-1249
Mailing Address - Fax:
Practice Address - Street 1:250 W OCEAN BLVD APT 1606
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-7945
Practice Address - Country:US
Practice Address - Phone:301-335-1249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-27
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60587475122300000X
CA100077122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist