Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 59781 | CA |
N | 204E00000X | Oral & Maxillofacial Surgeon | A124710 | CA |
NPI | 1316080450 |
---|---|
Provider Name | Hessam S Siavash |
First Address | Ventura, CA 93003-4185 |
Second Address | Ventura, CA 93003-4185 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2007 |
Last Update Date | 20/04/2017 |