Provider Demographics
NPI:1851975734
Name:SARDARI, YASAMAN (DDS)
Entity Type:Individual
Prefix:
First Name:YASAMAN
Middle Name:
Last Name:SARDARI
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 1:6154 CALLE CAMPOSECO
Mailing Address - Street 2:#3908
Mailing Address - City:RANCHO SANTA FE
Mailing Address - State:CA
Mailing Address - Zip Code:92067
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2333 CAMINO DEL RIO S STE 40
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3607
Practice Address - Country:US
Practice Address - Phone:619-574-1810
Practice Address - Fax:619-574-1326
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-07
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA105712122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist