Healthcare Provider Details

I. General information

NPI: 1669626511
Provider Name (Legal Business Name): JOSEPH SAYED BAHA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2008
Last Update Date: 03/05/2021
Certification Date: 03/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 W GLENOAKS BLVD SUITE 203
GLENDALE CA
91201-2231
US

IV. Provider business mailing address

26756 BARONET
MISSION VIEJO CA
92692-4174
US

V. Phone/Fax

Practice location:
  • Phone: 518-227-2703
  • Fax:
Mailing address:
  • Phone: 518-227-2703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number62932
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number054219-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number62932
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: