Provider Demographics
NPI:1497890768
Name:SAYEDNA, SHAHRAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHAHRAM
Middle Name:
Last Name:SAYEDNA
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 1:1700 WESTWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-5608
Mailing Address - Country:US
Mailing Address - Phone:310-470-3095
Mailing Address - Fax:310-470-3007
Practice Address - Street 1:1700 WESTWOOD BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-5608
Practice Address - Country:US
Practice Address - Phone:310-470-3095
Practice Address - Fax:310-470-3007
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA476601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice