Provider Demographics
NPI:1215082672
Name:TALE-YAZDI, FOROUD (DDS)
Entity type:Individual
Prefix:DR
First Name:FOROUD
Middle Name:
Last Name:TALE-YAZDI
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 1:700 E OCEAN BLVD
Mailing Address - Street 2:APT # 1101
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-5044
Mailing Address - Country:US
Mailing Address - Phone:619-518-0748
Mailing Address - Fax:
Practice Address - Street 1:25411 TRABUCO RD
Practice Address - Street 2:SUITE 112
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-2777
Practice Address - Country:US
Practice Address - Phone:949-581-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019027233122300000X
CA48386122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist