Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 54371 | CA |
N | 1223D0001X | Dental Public Health | 0401410833 | VA |
NPI | 1427159748 |
---|---|
Provider Name | Dr. Cameron Heydari |
First Address | Calabasas, CA 91302-2612 |
Second Address | Lancaster, CA 93535-1916 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2006 |
Last Update Date | 25/08/2014 |