Provider Demographics
NPI:1659425247
Name:KAMRAN SAHABI D.D.S., A PROFESSIONAL DENTAL CORPORATION
Entity Type:Organization
Organization Name:KAMRAN SAHABI D.D.S., A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:CALIFORNIA DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT-CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KAMRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SAHABI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-395-4833
Mailing Address - Street 1:5841 FIRESTONE BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:SOUTH GATE
Mailing Address - State:CA
Mailing Address - Zip Code:90280-3716
Mailing Address - Country:US
Mailing Address - Phone:562-806-8611
Mailing Address - Fax:562-806-8615
Practice Address - Street 1:5841 FIRESTONE BLVD STE C
Practice Address - Street 2:
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280-3716
Practice Address - Country:US
Practice Address - Phone:562-806-8611
Practice Address - Fax:562-806-8615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Single Specialty