Healthcare Provider Details

I. General information

NPI: 1447750963
Provider Name (Legal Business Name): SAHABI-MORAVVEJI DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2018
Last Update Date: 02/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 BROADVIEW DR
GLENDALE CA
91208-1313
US

IV. Provider business mailing address

4701 EAGLE ROCK BLVD
LOS ANGELES CA
90041-2711
US

V. Phone/Fax

Practice location:
  • Phone: 818-395-3833
  • Fax:
Mailing address:
  • Phone: 818-395-4833
  • Fax: 818-790-3885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. KAMRAN SAHABI
Title or Position: PRESIDENT
Credential: DDS
Phone: 818-395-4833