Provider Demographics
NPI:1851522866
Name:DELJOUI, SAMAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:SAMAN
Middle Name:
Last Name:DELJOUI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:SAMAN
Other - Middle Name:
Other - Last Name:DELJOUI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:9100 WILSHIRE BLVD STE 448W
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-3473
Mailing Address - Country:US
Mailing Address - Phone:310-273-2020
Mailing Address - Fax:
Practice Address - Street 1:1779 DOMINICAN WAY
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95065-1526
Practice Address - Country:US
Practice Address - Phone:831-475-2833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-07
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA586361223E0200X, 1223E0200X
NY0568671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No1223G0001XDental ProvidersDentistGeneral Practice