Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0004X | Dentist Anesthesiologist | 55455 | CA |
NPI | 1417149915 |
---|---|
Provider Name | Dr. Vahe Sam Sardaryanst |
First Address | Irvine, CA 92604-3078 |
Second Address | Irvine, CA 92604-3078 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2007 |
Last Update Date | 07/09/2016 |