Provider Demographics
NPI:1942423546
Name:RABIZADEH, DAVID SHAHRAM (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:SHAHRAM
Last Name:RABIZADEH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 E WHITTIER BLVD
Mailing Address - Street 2:#D
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90023
Mailing Address - Country:US
Mailing Address - Phone:323-526-1992
Mailing Address - Fax:323-526-1742
Practice Address - Street 1:2901 E WHITTIER BLVD
Practice Address - Street 2:#D
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90023
Practice Address - Country:US
Practice Address - Phone:323-526-1992
Practice Address - Fax:323-526-1742
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41984122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist