Provider Demographics
NPI:1285886150
Name:YOSI PAYAM BEHROOZAN DDS INC.
Entity type:Organization
Organization Name:YOSI PAYAM BEHROOZAN DDS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YOSI
Authorized Official - Middle Name:PAYAM
Authorized Official - Last Name:BEHROOZAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-399-1100
Mailing Address - Street 1:2221 LINCOLN BLVD
Mailing Address - Street 2:200
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-1320
Mailing Address - Country:US
Mailing Address - Phone:310-399-1100
Mailing Address - Fax:310-664-8901
Practice Address - Street 1:2221 LINCOLN BLVD
Practice Address - Street 2:200
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-1320
Practice Address - Country:US
Practice Address - Phone:310-399-1100
Practice Address - Fax:310-664-8901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-22
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50038122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty