Healthcare Provider Details

I. General information

NPI: 1497097042
Provider Name (Legal Business Name): KSAHABI, D.D.S., INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2013
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 S GLENDALE AVE
GLENDALE CA
91205-2315
US

IV. Provider business mailing address

609 S GLENDALE AVE
GLENDALE CA
91205-2315
US

V. Phone/Fax

Practice location:
  • Phone: 818-543-3222
  • Fax: 818-543-3292
Mailing address:
  • Phone: 818-543-3222
  • Fax: 818-543-3292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

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