Provider Demographics
NPI:1992804652
Name:AZIZI, JOSEPH (DMD)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:
Last Name:AZIZI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:MR
Other - First Name:JOSEPH
Other - Middle Name:
Other - Last Name:AZIZI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:14011 S VAN NESS AVE
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90249
Mailing Address - Country:US
Mailing Address - Phone:310-327-0404
Mailing Address - Fax:310-327-1426
Practice Address - Street 1:14011 S VAN NESS AVE
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90249
Practice Address - Country:US
Practice Address - Phone:310-327-0404
Practice Address - Fax:310-327-1426
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39939122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist