MEDICARE: MARYAM SEIRAFI 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	1223G0001X	General Practice Dentistry	59411	CA

General Provider Information

NPI Number	:	1720390958
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARYAM SEIRAFI D.D.S

Provider Business Mailing Address
First Line	:	531 W 7TH ST
Second Line	:
City	:	SAN PEDRO
State	:	CA
Zip	:	90731-3115
Country	:	US
Telephone Number	:	310-831-0003
Fax Number	:	310-831-0059

Provider Business Practice Location Address
First Line	:	5350 DUNLAY DR UNIT 1414
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95835-1578
Country	:	US
Telephone Number	:	916-515-1119
Fax Number	:

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

Provider Enumeration Date	:	07/02/2010
Last Update Date	:	03/07/2013

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