Provider Demographics
NPI:1083058986
Name:SALEHPOUR, MAYSAM MAGID
Entity Type:Individual
Prefix:DR
First Name:MAYSAM
Middle Name:MAGID
Last Name:SALEHPOUR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5153 JACKSON DR
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-9021
Mailing Address - Country:US
Mailing Address - Phone:949-280-3009
Mailing Address - Fax:619-460-2285
Practice Address - Street 1:5153 JACKSON DR
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-9021
Practice Address - Country:US
Practice Address - Phone:619-460-2280
Practice Address - Fax:619-460-2285
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-22
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA615271223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice