Provider Demographics
NPI:1144584046
Name:SADEGHEIN, KAMYAR (DDS)
Entity Type:Individual
Prefix:DR
First Name:KAMYAR
Middle Name:
Last Name:SADEGHEIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8077 FLORENCE AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90240-3894
Mailing Address - Country:US
Mailing Address - Phone:818-205-8949
Mailing Address - Fax:
Practice Address - Street 1:8077 FLORENCE AVE STE 101
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90240-3894
Practice Address - Country:US
Practice Address - Phone:818-205-8949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-26
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
244202390200000X
CA653431223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program