MEDICARE: FERESHTEH ANGELA SONBOLIAN

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	122300000X	Dentist	60479	CA

General Provider Information

NPI Number	:	1932496700
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FERESHTEH ANGELA SONBOLIAN

Provider Business Mailing Address
First Line	:	6507 MOORE DR
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-5325
Country	:	US
Telephone Number	:	310-402-1449
Fax Number	:

Provider Business Practice Location Address
First Line	:	6507 MOORE DR
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-5325
Country	:	US
Telephone Number	:	310-402-1449
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2011
Last Update Date	:	01/25/2021

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