Healthcare Provider Details

I. General information

NPI: 1205744265
Provider Name (Legal Business Name): STEVAN SAMI MOSHI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

913 STONEYS LN
EL CAJON CA
92021-7700
US

IV. Provider business mailing address

913 STONEYS LN
EL CAJON CA
92021-7700
US

V. Phone/Fax

Practice location:
  • Phone: 619-292-9518
  • Fax:
Mailing address:
  • Phone: 619-292-9518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number1267
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: