Provider Demographics
NPI:1982761284
Name:SIGAROUDI, KHOSROW (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:KHOSROW
Middle Name:
Last Name:SIGAROUDI
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 SUTTER ST RM 1608
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94108-4005
Mailing Address - Country:US
Mailing Address - Phone:415-989-4500
Mailing Address - Fax:
Practice Address - Street 1:450 SUTTER ST RM 1608
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108-4005
Practice Address - Country:US
Practice Address - Phone:415-989-4500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35167122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist