Provider Demographics
NPI:1528705993
Name:AZIMI, HOSSEIN (DDS)
Entity type:Individual
Prefix:DR
First Name:HOSSEIN
Middle Name:
Last Name:AZIMI
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 1:5302 PLUM TREE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-2342
Mailing Address - Country:US
Mailing Address - Phone:716-313-0465
Mailing Address - Fax:
Practice Address - Street 1:1730 SEPULVEDA BLVD STE 1
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-6901
Practice Address - Country:US
Practice Address - Phone:310-325-8888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-17
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND147471223G0001X
CA1088221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice