Healthcare Provider Details

I. General information

NPI: 1053097774
Provider Name (Legal Business Name): SABA CHUGHTAI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2023
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3909 SEPULVEDA BLVD # 18
LOS ANGELES CA
90230-4607
US

IV. Provider business mailing address

3909 SEPULVEDA BLVD
LOS ANGELES CA
90230-4607
US

V. Phone/Fax

Practice location:
  • Phone: 310-390-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDDS112338
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: