Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 18833 | CA |
NPI | 1023401734 |
---|---|
Provider Name | Afsaneh S Dadseresht |
First Address | Los Angeles, CA 90035-1132 |
Second Address | Los Angeles, CA 90035-1132 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2015 |
Last Update Date | 05/03/2015 |