Provider Demographics
NPI:1447556840
Name:KEIVAN SARRAF, DDS, INC
Entity Type:Organization
Organization Name:KEIVAN SARRAF, DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KEIVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SARRAF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-460-9546
Mailing Address - Street 1:3060 BALDWIN PARK BLVD STE D100
Mailing Address - Street 2:
Mailing Address - City:BALDWIN PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91706-4704
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3060 BALDWIN PARK BLVD STE D100
Practice Address - Street 2:
Practice Address - City:BALDWIN PARK
Practice Address - State:CA
Practice Address - Zip Code:91706-4704
Practice Address - Country:US
Practice Address - Phone:310-460-9546
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KEIVAN SARRAF, DDS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-02-02
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty