MEDICARE: AMIR SADJADI DMD

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	52313	CA

General Provider Information

NPI Number	:	1871660670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMIR SADJADI DMD

Provider Business Mailing Address
First Line	:	PO BOX 3430
Second Line	:
City	:	FULLERTON
State	:	CA
Zip	:	92834-3430
Country	:	US
Telephone Number	:	714-891-6623
Fax Number	:

Provider Business Practice Location Address
First Line	:	11001 BEACH BLVD
Second Line	:
City	:	STANTON
State	:	CA
Zip	:	90680-3216
Country	:	US
Telephone Number	:	714-891-6623
Fax Number	:

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

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	07/08/2007

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