Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | DDS105601 | CA |
NPI | 1053939991 |
---|---|
Provider Name | Talayeh Azarpajouh |
First Address | Tustin, CA 92782-8706 |
Second Address | Costa Mesa, CA 92626-2562 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2020 |
Last Update Date | 23/11/2020 |