MEDICARE: SAHAR MOEINI DENTAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1356188924
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAHAR MOEINI DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	11022 SANTA MONICA BLVD STE 440
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-7566
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5757 WILSHIRE BLVD STE 660
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90036-3691
Country	:	US
Telephone Number	:	323-930-2386
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SAHAR MOEINI
Credential	:	DMD
Telephone Number	:	925-330-5828

Provider Enumeration Date	:	07/11/2024
Last Update Date	:	07/11/2024

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