Healthcare Provider Details

I. General information

NPI: 1699923375
Provider Name (Legal Business Name): SIAMAK ABAI D.D.S., M.MED.SC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2008
Last Update Date: 12/01/2020
Certification Date: 12/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1431 WARNER AVE STE E
TUSTIN CA
92780-6444
US

IV. Provider business mailing address

16300 SAND CANYON AVE STE 506
IRVINE CA
92618-3705
US

V. Phone/Fax

Practice location:
  • Phone: 949-648-0303
  • Fax:
Mailing address:
  • Phone: 949-201-4444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number54930
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: