Provider Demographics
NPI:1760634695
Name:SAHARA, RICHARD KIYOSHI (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:KIYOSHI
Last Name:SAHARA
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 1:433 N 4TH ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-4311
Mailing Address - Country:US
Mailing Address - Phone:323-888-1030
Mailing Address - Fax:323-888-1011
Practice Address - Street 1:433 N 4TH ST
Practice Address - Street 2:SUITE 210
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-4311
Practice Address - Country:US
Practice Address - Phone:323-888-1030
Practice Address - Fax:323-888-1011
Is Sole Proprietor?:No
Enumeration Date:2008-10-22
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20581122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist