Provider Demographics
NPI:1932548591
Name:OHANESIAN, SAKO (DDS, MAGD)
Entity Type:Individual
Prefix:
First Name:SAKO
Middle Name:
Last Name:OHANESIAN
Suffix:
Gender:M
Credentials:DDS, MAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 S CHAPARRAL CT
Mailing Address - Street 2:SUITE # 201
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92808-2265
Mailing Address - Country:US
Mailing Address - Phone:714-998-1646
Mailing Address - Fax:270-675-9517
Practice Address - Street 1:145 S CHAPARRAL CT
Practice Address - Street 2:SUITE # 201
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92808-2265
Practice Address - Country:US
Practice Address - Phone:714-998-1646
Practice Address - Fax:270-675-9517
Is Sole Proprietor?:No
Enumeration Date:2013-06-17
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38213122300000X
CADDS382131223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1528150554OtherNPI TYPE 2 CORPORATION