Healthcare Provider Details

I. General information

NPI: 1629213368
Provider Name (Legal Business Name): SAHAND ZOMORRODIAN BS, MA,MS, DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2008
Last Update Date: 06/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 E WOODFIELD RD STE 510
SCHAUMBURG IL
60173-5130
US

IV. Provider business mailing address

1701 E WOODFIELD RD STE 510
SCHAUMBURG IL
60173-5130
US

V. Phone/Fax

Practice location:
  • Phone: 847-437-3533
  • Fax: 847-473-0310
Mailing address:
  • Phone: 847-437-3533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019.027767
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: