Provider Demographics
NPI:1902077365
Name:SHAHRAM SAYEDNA DDS INC
Entity Type:Organization
Organization Name:SHAHRAM SAYEDNA DDS INC
Other - Org Name:DR SAYEDNA
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAHRAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SAYEDNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-666-3707
Mailing Address - Street 1:1700 WESTWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:LA
Mailing Address - State:CA
Mailing Address - Zip Code:90024
Mailing Address - Country:US
Mailing Address - Phone:310-470-3095
Mailing Address - Fax:310-470-3007
Practice Address - Street 1:1700 WESTWOOD BLVD
Practice Address - Street 2:
Practice Address - City:LA
Practice Address - State:CA
Practice Address - Zip Code:90024
Practice Address - Country:US
Practice Address - Phone:310-470-3095
Practice Address - Fax:310-470-3007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-13
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47660122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG9278701Medicare PIN