Provider Demographics
NPI:1891198339
Name:ZAMANI, PAYAM (DDS, MDS)
Entity type:Individual
Prefix:DR
First Name:PAYAM
Middle Name:
Last Name:ZAMANI
Suffix:
Gender:M
Credentials:DDS, MDS
Other - Prefix:DR
Other - First Name:PIAM
Other - Middle Name:
Other - Last Name:ZAMANI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS, MDS
Mailing Address - Street 1:194 S ALVARADO ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-2211
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:194 S ALVARADO ST,
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057
Practice Address - Country:US
Practice Address - Phone:213-927-2030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-29
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS040202122300000X
CA645281223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist