1215681614 NPI number — SIAVASH GOLABY SANAJANY DMD INC

Table of content: MRS. BEULAH BRAWNER SHAW CCCSLP (NPI 1033469820)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215681614 NPI number — SIAVASH GOLABY SANAJANY DMD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SIAVASH GOLABY SANAJANY DMD INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215681614
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/21/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10921 WILSHIRE BLVD STE 1212
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90024-4000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-922-4057
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10921 WILSHIRE BLVD STE 1212
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90024-4000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-922-4057
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/05/2022

Additional Information

Authorized Official

Authorized Official Last Name:
GOLABY SANAJANY
Authorized Official First Name:
SIAVASH
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
818-922-4057

Provider Taxonomy Codes

  • Taxonomy code: 122300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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