Healthcare Provider Details

I. General information

NPI: 1528161775
Provider Name (Legal Business Name): FARIBA SARDARIAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1406 N AZUSA AVE SUITE C
COVINA CA
91722-1257
US

IV. Provider business mailing address

2860 MICHELLE 2ND FLOOR
IRVINE CA
92606-1009
US

V. Phone/Fax

Practice location:
  • Phone: 626-858-9940
  • Fax: 626-858-9366
Mailing address:
  • Phone: 714-508-3600
  • Fax: 714-368-2092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number46327
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: