Provider Demographics
NPI:1912179904
Name:SAHAKI, IRINA M (DDS)
Entity Type:Individual
Prefix:
First Name:IRINA
Middle Name:M
Last Name:SAHAKI
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 1:5420 SYEMON AV
Mailing Address - Street 2:#223
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91401
Mailing Address - Country:US
Mailing Address - Phone:818-786-6016
Mailing Address - Fax:818-786-6016
Practice Address - Street 1:520 EAST BROADWAY
Practice Address - Street 2:SUITE #402
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205
Practice Address - Country:US
Practice Address - Phone:818-241-2424
Practice Address - Fax:818-241-4646
Is Sole Proprietor?:No
Enumeration Date:2008-03-31
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA434911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice