Koushan H. Azad Professional Dental Corporation

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

KOUSHAN H. AZAD PROFESSIONAL DENTAL CORPORATION

Doing business as

CaliDental Marina

Practice address

272 Reservation Rd
Marina, CA 93933-3178

Phone

(805) 242-4044

NPI assigned

Jul 31, 2024

Last updated

Jul 31, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Koushan AzadNPI 1154533180

Title

President

Phone

(805) 242-4044

Specialties & licenses 1

Addresses

Other names 1

• CaliDental Marina Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Koushan Haidarzadeh Azad, DMD

  • General Practice Dentistry
  • Lompoc, CA
  • NPI 1154533180
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1722384000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722384000000",
    "number": "1912736588",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "272 RESERVATION RD",
            "city": "MARINA",
            "state": "CA",
            "postal_code": "939333178"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "272 RESERVATION RD",
            "city": "MARINA",
            "state": "CA",
            "postal_code": "939333178",
            "telephone_number": "805-242-4044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KOUSHAN H. AZAD PROFESSIONAL DENTAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-31",
        "last_updated": "2024-07-31",
        "certification_date": "2024-07-31",
        "status": "A",
        "authorized_official_last_name": "AZAD",
        "authorized_official_first_name": "KOUSHAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "805-242-4044"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CaliDental Marina",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Chang K Kim, L.AC., O.M.D., PH D.
• Jennifer Ahram Kim, PHARMD
• Steven A King, D.C.
• Jacqueline B. Kinville, PSYD
• Amber Marie Kitt
• Larissa Fedra Koutakos
• Judith Frieda Krieger, MA
• Renuka Kucherlapati
• David Kurtmen, M.D.
• La Cura Collective Corp.

• General Practice Dentistry in Marina, CA
• Providers in Marina, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.