Healthcare Provider Details

I. General information

NPI: 1033930474
Provider Name (Legal Business Name): SADEGHEIN PRO ENDO DENTAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2024
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8077 FLORENCE AVE STE 101
DOWNEY CA
90240-3894
US

IV. Provider business mailing address

8077 FLORENCE AVE STE 101
DOWNEY CA
90240-3894
US

V. Phone/Fax

Practice location:
  • Phone: 562-381-2442
  • Fax: 888-977-3635
Mailing address:
  • Phone: 562-381-2442
  • Fax: 888-977-3635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: KAMYAR SADEGHEIN
Title or Position: CEO
Credential: DDS
Phone: 818-205-8949