Provider Demographics
NPI:1568556025
Name:NAMAZIKHAH, M. SADEGH (DMD, MSED)
Entity type:Individual
Prefix:DR
First Name:M. SADEGH
Middle Name:
Last Name:NAMAZIKHAH
Suffix:
Gender:M
Credentials:DMD, MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16661 VENTURA BLVD STE 606
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-1982
Mailing Address - Country:US
Mailing Address - Phone:818-789-3236
Mailing Address - Fax:818-789-3228
Practice Address - Street 1:16661 VENTURA BLVD STE 606
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-1982
Practice Address - Country:US
Practice Address - Phone:818-789-3236
Practice Address - Fax:818-789-3228
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA313411223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA954535867OtherTAX ID
CA823393477OtherENDODONTICS