Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 54027 | CA |
Y | 213EG0000X | General Practice | 54027 | CA |
N | 1223G0001X | General Practice | DDS54027 | CA |
N | 213EG0000X | General Practice | DDS54027 | CA |
NPI | 1003919127 |
---|---|
Provider Name | Faezeh Sadeghi |
First Address | Oakland, CA 94623-2210 |
Second Address | Oakland, CA 94601 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2006 |
Last Update Date | 23/08/2013 |