Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 41852 | CA |
NPI | 1114936523 |
---|---|
Provider Name | Reza Malekzadeh |
First Address | Long Beach, CA 90807 |
Second Address | Long Beach, CA 90807 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2006 |
Last Update Date | 08/07/2007 |