Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 49985 | CA |
N | 1223G0001X | General Practice | 49985 | CA |
N | 213EG0000X | General Practice | 49985 | CA |
Y | 1223P0700X | Prosthodontist | 49985 | CA |
NPI | 1093246795 |
---|---|
Provider Name | Said Jalil Sadri |
First Address | Oakland, CA 94611-3225 |
Second Address | Oakland, CA 94611-3225 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2017 |
Last Update Date | 23/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D4603092 | DRIVER LICENSE (01) | CA |