Provider Demographics
NPI:1992843643
Name:SADEGHI, AMINOLLAH
Entity Type:Individual
Prefix:DR
First Name:AMINOLLAH
Middle Name:
Last Name:SADEGHI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 E COUNTRY VIEW CIR
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-0725
Mailing Address - Country:US
Mailing Address - Phone:559-229-6249
Mailing Address - Fax:559-369-7176
Practice Address - Street 1:125 E BARSTOW AVE STE 122
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5023
Practice Address - Country:US
Practice Address - Phone:559-229-6249
Practice Address - Fax:559-369-7176
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50519122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD50519Medicaid