Healthcare Provider Details

I. General information

NPI: 1154576619
Provider Name (Legal Business Name): SAHAR VERDI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2008
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11500 W OLYMPIC BLVD STE 335
LOS ANGELES CA
90064-1527
US

IV. Provider business mailing address

11500 W OLYMPIC BLVD STE 335
LOS ANGELES CA
90064-1527
US

V. Phone/Fax

Practice location:
  • Phone: 310-477-1691
  • Fax: 310-575-1591
Mailing address:
  • Phone: 310-477-1691
  • Fax: 310-575-1591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number51775
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: