Provider Demographics
NPI:1679637821
Name:MASOUM, SEDIGHEH E (DDS)
Entity Type:Individual
Prefix:
First Name:SEDIGHEH
Middle Name:E
Last Name:MASOUM
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 1:25571 JERONIMO RD
Mailing Address - Street 2:STE 11
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-2726
Mailing Address - Country:US
Mailing Address - Phone:949-707-5533
Mailing Address - Fax:
Practice Address - Street 1:25571 JERONIMO RD
Practice Address - Street 2:STE 11
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-2726
Practice Address - Country:US
Practice Address - Phone:949-707-5533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41475122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist