Provider Demographics
NPI:1245626977
Name:SAYAN, ARDALAN
Entity type:Individual
Prefix:
First Name:ARDALAN
Middle Name:
Last Name:SAYAN
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 1:705 N 8TH AVE STE 1B
Mailing Address - Street 2:
Mailing Address - City:DILLON
Mailing Address - State:SC
Mailing Address - Zip Code:29536-2549
Mailing Address - Country:US
Mailing Address - Phone:843-487-1588
Mailing Address - Fax:843-487-1590
Practice Address - Street 1:705 N 8TH AVE STE 1B
Practice Address - Street 2:
Practice Address - City:DILLON
Practice Address - State:SC
Practice Address - Zip Code:29536-2549
Practice Address - Country:US
Practice Address - Phone:843-487-1588
Practice Address - Fax:843-487-1590
Is Sole Proprietor?:No
Enumeration Date:2015-04-09
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCMD85554207XS0114X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery