Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 10410 | AZ |
N | 1223S0112X | Oral and Maxillofacial Surgeon | 62878 | CA |
NPI | 1043646698 |
---|---|
Provider Name | Rozbeh Hossieni |
First Address | Los Angeles, CA 90033-1029 |
Second Address | Los Angeles, CA 90033-1029 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2013 |
Last Update Date | 08/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
62878 | DENTAL LICENSE (01) | CA |