Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 63560 | CA |
Y | 204E00000X | Oral & Maxillofacial Surgeon | A151497 | CA |
NPI | 1285952234 |
---|---|
Provider Name | Dr. Saman Vahedi |
First Address | Los Angeles, CA 90025 |
Second Address | Los Angeles, CA 90035-1403 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2010 |
Last Update Date | 05/09/2017 |