Healthcare Provider Details

I. General information

NPI: 1265350938
Provider Name (Legal Business Name): MARYAM SAKHAEI MANESH DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31180 ROAD 72
VISALIA CA
93291-9672
US

IV. Provider business mailing address

25262 NORTHRUP DR
LAGUNA HILLS CA
92653-5223
US

V. Phone/Fax

Practice location:
  • Phone: 559-737-4904
  • Fax:
Mailing address:
  • Phone: 716-463-1131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number113419
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: