MEDICARE: SARA BAHRI SABOKPEY 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	105424	CA

General Provider Information

NPI Number	:	1912530585
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA BAHRI SABOKPEY DDS

Provider Business Mailing Address
First Line	:	2001 STRADELLA RD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90077-2322
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2001 STRADELLA RD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90077-2322
Country	:	US
Telephone Number	:	949-302-9275
Fax Number	:

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

Provider Enumeration Date	:	02/21/2020
Last Update Date	:	09/06/2020

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