Provider Demographics
NPI:1649167289
Name:KEBRIAEI, SAHAR (DDS)
Entity type:Individual
Prefix:
First Name:SAHAR
Middle Name:
Last Name:KEBRIAEI
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 1:158 S MADISON AVE APT 206
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-2569
Mailing Address - Country:US
Mailing Address - Phone:818-818-2401
Mailing Address - Fax:
Practice Address - Street 1:1717 WALNUT GROVE AVE STE 500
Practice Address - Street 2:
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-3799
Practice Address - Country:US
Practice Address - Phone:626-737-6917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-18
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA111648122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist