Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 8754 | NC |
N | 1223G0001X | General Practice | 8754 | NC |
N | 213EG0000X | General Practice | 8754 | NC |
NPI | 1710112800 |
---|---|
Provider Name | Homayoun Sadri |
First Address | Burlington, NC 27217-2954 |
Second Address | Burlington, NC 27217-2954 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2009 |
Last Update Date | 01/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5913811 | (05) | NC |