Provider Demographics
NPI:1588098628
Name:BASSIR, SEYED HOSSEIN (DDS)
Entity type:Individual
Prefix:DR
First Name:SEYED HOSSEIN
Middle Name:
Last Name:BASSIR
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 1:2220 AVE OF STARS UNIT 404
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90067-5656
Mailing Address - Country:US
Mailing Address - Phone:310-801-4208
Mailing Address - Fax:
Practice Address - Street 1:1890 W REDONDO BEACH BLVD
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-3662
Practice Address - Country:US
Practice Address - Phone:310-801-4208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-26
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0000931223P0300X
TX331231223P0300X
CADDS1059461223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics