Healthcare Provider Details

I. General information

NPI: 1619549573
Provider Name (Legal Business Name): ARYAN SADIGHIM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2021
Last Update Date: 07/19/2021
Certification Date: 07/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5703 S VERMONT AVE
LOS ANGELES CA
90037-3930
US

IV. Provider business mailing address

1923 BENECIA AVE
LOS ANGELES CA
90025-5105
US

V. Phone/Fax

Practice location:
  • Phone: 323-751-5600
  • Fax:
Mailing address:
  • Phone: 310-500-5962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number106473
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: