Provider Demographics
NPI:1295867851
Name:MEHRGAN, SOHRAB (DDS)
Entity Type:Individual
Prefix:
First Name:SOHRAB
Middle Name:
Last Name:MEHRGAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8485 FLORENCE AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90240-3918
Mailing Address - Country:US
Mailing Address - Phone:562-869-2091
Mailing Address - Fax:562-861-0190
Practice Address - Street 1:8485 FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90240-3918
Practice Address - Country:US
Practice Address - Phone:562-869-2091
Practice Address - Fax:562-861-0190
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA519731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice