Healthcare Provider Details

I. General information

NPI: 1326591223
Provider Name (Legal Business Name): SAIF ISSAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2016
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3177 OCEAN VIEW BLVD
SAN DIEGO CA
92113-1432
US

IV. Provider business mailing address

3177 OCEAN VIEW BLVD
SAN DIEGO CA
92113-1432
US

V. Phone/Fax

Practice location:
  • Phone: 619-662-4100
  • Fax: 619-232-5922
Mailing address:
  • Phone: 619-662-4100
  • Fax: 619-232-5922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDDS103212
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: