Provider Demographics
NPI:1225237357
Name:SOHRAB, SANAH AMIR (DDS)
Entity Type:Individual
Prefix:DR
First Name:SANAH
Middle Name:AMIR
Last Name:SOHRAB
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 1:1824 WEST VERDUGO AVENUE
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91506
Mailing Address - Country:US
Mailing Address - Phone:818-566-8715
Mailing Address - Fax:818-528-8784
Practice Address - Street 1:1824 W VERDUGO AVE
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91506-2150
Practice Address - Country:US
Practice Address - Phone:818-566-8715
Practice Address - Fax:818-528-8784
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA557411223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1225237357Medicaid