Healthcare Provider Details

I. General information

NPI: 1932540614
Provider Name (Legal Business Name): KAMRAN SAHABI D D S INC TUSTIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2013
Last Update Date: 01/10/2022
Certification Date: 01/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13424 WOODRUFF AVE
BELLFLOWER CA
90706-2629
US

IV. Provider business mailing address

13424 WOODRUFF AVE
BELLFLOWER CA
90706-2629
US

V. Phone/Fax

Practice location:
  • Phone: 562-461-8000
  • Fax:
Mailing address:
  • Phone: 818-395-4833
  • Fax: 818-790-3885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number39202
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KAMRAN SAHABI
Title or Position: PRESIDENT
Credential: DDS
Phone: 818-395-4833