=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184161606
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAHAR KAMKAR DMD, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/22/2017
-----------------------------------------------------
Last Update Date | 04/03/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20 E 46TH ST SUITE 1300
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10017-2417
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-580-8587
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 326 E 65TH ST SUITE 245
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10065-6746
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-580-8587
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. SAHAR KAMKAR
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 646-580-8587
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 056322
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------