Provider Demographics
NPI:1710081229
Name:HOANG, MARYAM SARRAFZADEH (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARYAM
Middle Name:SARRAFZADEH
Last Name:HOANG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5414 SUNRISE BLVD STE G
Mailing Address - Street 2:
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95610-7803
Mailing Address - Country:US
Mailing Address - Phone:916-863-5838
Mailing Address - Fax:916-863-5879
Practice Address - Street 1:5414 SUNRISE BLVD STE G
Practice Address - Street 2:
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95610-7803
Practice Address - Country:US
Practice Address - Phone:916-863-5838
Practice Address - Fax:916-863-5879
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2009-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53865122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist