Healthcare Provider Details

I. General information

NPI: 1538855598
Provider Name (Legal Business Name): DR. ANISHA SEBASTIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANISHA SEBASTIAN

II. Dates (important events)

Enumeration Date: 04/13/2023
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 S FREMONT AVE
ALHAMBRA CA
91801-3021
US

IV. Provider business mailing address

11761 CHIMINEAS AVE
PORTER RANCH CA
91326-3613
US

V. Phone/Fax

Practice location:
  • Phone: 626-604-1130
  • Fax:
Mailing address:
  • Phone: 818-439-3524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number104397
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: