Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 39695 | CA |
N | 1223D0001X | Dental Public Health | 39695 | CA |
NPI | 1245498229 |
---|---|
Provider Name | Dr. Azadeh Paydar |
First Address | Rancho Cucamonga, CA 91739-9334 |
Second Address | Rancho Cucamonga, CA 91739-9334 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2008 |
Last Update Date | 27/05/2008 |