| |
5841 Firestone Blvd Ste C South Gate CA 90280-3716 | |
(562) 806-8611 | |
(562) 806-8615 |
Full Name | |
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Speciality | Dentist |
Location | 5841 Firestone Blvd Ste C, South Gate, California |
Authorized Official Name and Position | Kamran Sahabi (PRESIDENT-CEO) |
Authorized Official Contact | 8183954833 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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5841 Firestone Blvd Ste C South Gate CA 90280-3716 Ph: (562) 806-8611 | 5841 Firestone Blvd Ste C South Gate CA 90280-3716 Ph: (562) 806-8611 |
NPI Number | 1659425247 |
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Provider Enumeration Date | 01/22/2007 |
Last Update Date | 11/14/2019 |
Medicare PECOS PAC ID | 4183012636 |
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Medicare Enrollment ID | O20211102002321 |
Identifier | Type | State | Issuer |
---|---|---|---|
1659425247 | NPI | - | NPPES |
Provider Name | Kamran Sahabi |
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Provider Type | Practitioner - Dentist |
Provider Identifiers | NPI Number: 1518387778 PECOS PAC ID: 6507168374 Enrollment ID: I20211007003567 |
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