MEDICARE: DR. SAYED MASOUD FADAVI D.D.S.

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	122300000X	Dentist	DE00010455	WA
2	122300000X	Dentist	DN14848	FL
3	1223G0001X	General Practice Dentistry	DDS102131	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245247097
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAYED MASOUD FADAVI D.D.S.

Provider Business Mailing Address
First Line	:	8401 VAN NUYS BLVD UNIT 26
Second Line	:
City	:	PANORAMA CITY
State	:	CA
Zip	:	91402-3360
Country	:	US
Telephone Number	:	954-258-8098
Fax Number	:

Provider Business Practice Location Address
First Line	:	8401 VAN NUYS BLVD UNIT 26
Second Line	:
City	:	PANORAMA CITY
State	:	CA
Zip	:	91402-3360
Country	:	US
Telephone Number	:	954-258-8098
Fax Number	:

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

Provider Enumeration Date	:	08/02/2006
Last Update Date	:	05/28/2021

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Directions to “ DR. SAYED MASOUD FADAVI D.D.S.” Practice Location

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