Healthcare Provider Details

I. General information

NPI: 1710708433
Provider Name (Legal Business Name): KAMYAR SADEGHEIN DDS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2024
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12015 GARVEY AVE STE A
EL MONTE CA
91732-3156
US

IV. Provider business mailing address

12015 GARVEY AVE STE A
EL MONTE CA
91732-3156
US

V. Phone/Fax

Practice location:
  • Phone: 626-522-8998
  • Fax:
Mailing address:
  • Phone: 626-522-8998
  • Fax:

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:
Phone: 626-522-8998