Provider Demographics
NPI:1144715285
Name:HOSAIN, KAZI MONWAR (RDAEF)
Entity type:Individual
Prefix:
First Name:KAZI
Middle Name:MONWAR
Last Name:HOSAIN
Suffix:
Gender:M
Credentials:RDAEF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 S MANHATTAN PL APT 11
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-4083
Mailing Address - Country:US
Mailing Address - Phone:213-255-1250
Mailing Address - Fax:
Practice Address - Street 1:350 S MANHATTAN PL APT 11
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-4083
Practice Address - Country:US
Practice Address - Phone:213-255-1250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-29
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA942126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant