Koushan H. Azad Professional Dental Corporation

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

KOUSHAN H. AZAD PROFESSIONAL DENTAL CORPORATION

Practice address

272 Reservation Rd
Marina, CA 93933-3178

Phone

(805) 242-4044

NPI assigned

Jul 31, 2024

Organization subpart

No

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

Authorized official

Name

Koushan Azad

Title

President

Phone

(805) 242-4044

Specialties & licenses 1

Addresses

Other names 1

• CaliDental Marina Doing business as

Locations

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.