=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528211299
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | YASAMAN SANI, DDS INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/28/2008
-----------------------------------------------------
Last Update Date | 08/06/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1270 E. LELAND RD. SUITE 101
-----------------------------------------------------
City | PITTSBURG
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94565
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-427-0123
-----------------------------------------------------
Fax | 925-252-0566
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1270 E. LELAND RD. STE. 101
-----------------------------------------------------
City | PITTSBURG
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94565
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-427-0123
-----------------------------------------------------
Fax | 925-252-0566
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. YASAMAN SANI
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 925-588-4294
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 53029
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------