Healthcare Provider Details

I. General information

NPI: 1609479567
Provider Name (Legal Business Name): SIAMAK SAHAND DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2020
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14440 OLYMPIC DRIVE
CLEARLAKE CA
95422-8809
US

IV. Provider business mailing address

7547 QUAKERTOWN AVE
WINNETKA CA
91306-2925
US

V. Phone/Fax

Practice location:
  • Phone: 707-263-8383
  • Fax: 707-263-5019
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number105775
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: