MEDICARE: DR. NAS SEDIQI DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	055232	NY
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	1001955	WI
3	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	P65488	NY
4	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	103573	CA

General Provider Information

NPI Number	:	1194969378
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NAS SEDIQI DDS

Provider Business Mailing Address
First Line	:	24102 EL TORO RD STE A
Second Line	:
City	:	LAGUNA WOODS
State	:	CA
Zip	:	92637-3123
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	24102 EL TORO RD STE A
Second Line	:
City	:	LAGUNA WOODS
State	:	CA
Zip	:	92637-3123
Country	:	US
Telephone Number	:	949-830-6510
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2009
Last Update Date	:	05/25/2021

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