Provider Demographics
NPI:1255430765
Name:SAHAFI DDS PROFESSIONAL CORP, KATAYOUN
Entity type:Individual
Prefix:DR
First Name:KATAYOUN
Middle Name:
Last Name:SAHAFI DDS PROFESSIONAL CORP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 DOVER DR STE 5
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-5721
Mailing Address - Country:US
Mailing Address - Phone:949-548-0966
Mailing Address - Fax:949-548-9796
Practice Address - Street 1:601 DOVER DR STE 5
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-5721
Practice Address - Country:US
Practice Address - Phone:949-548-0966
Practice Address - Fax:949-548-9796
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA496581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice