Provider Demographics
NPI:1811021843
Name:SOHRAB, PAYAM - (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAYAM
Middle Name:-
Last Name:SOHRAB
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 1:1 HIDDEN PASS
Mailing Address - Street 2:
Mailing Address - City:NEWPORT COAST
Mailing Address - State:CA
Mailing Address - Zip Code:92657-1648
Mailing Address - Country:US
Mailing Address - Phone:949-715-9973
Mailing Address - Fax:949-715-9974
Practice Address - Street 1:530 S MAIN ST FL 6
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4525
Practice Address - Country:US
Practice Address - Phone:714-480-3000
Practice Address - Fax:949-715-9974
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38365122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist