Individual
DR. KHASHAYAR AZIMI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2700 MARTIN LUTHER KING JR BLVD, DETROIT, MI 48208-2576
(313) 494-6944
Mailing address
1043 N WILSON AVE, ROYAL OAK, MI 48067-1415
(804) 549-8709
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2901022610
MI
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
05/02/2018
Last updated
03/04/2020
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