MEDICARE: SAHABI DENTAL CORP.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	1223E0200X	Endodontics
2	1223P0300X	Periodontics
3	1223S0112X	Oral and Maxillofacial Surgery (Dentist)
4	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry
5	124Q00000X	Dental Hygienist
6	261QD0000X	Dental Clinic/Center
7	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1801940598
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAHABI DENTAL CORP.

Provider Business Mailing Address
First Line	:	609 S GLENDALE AVE
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91205-2315
Country	:	US
Telephone Number	:	818-543-3222
Fax Number	:	818-790-3885

Provider Business Practice Location Address
First Line	:	609 S GLENDALE AVE
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91205-2315
Country	:	US
Telephone Number	:	818-543-3222
Fax Number	:	818-543-3292

Authorized Official
Title or Position	:	PRESIDENT-CEO
Name	:	DR. KAMRAN SAHABI
Credential	:	D.D.S.
Telephone Number	:	818-395-4833

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	08/04/2020

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