Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 3621 | OH |
Y | 1223D0004X | Dentist Anesthesiologist | 102587 | CA |
NPI | 1760868657 |
---|---|
Provider Name | Sanaz Mohseni |
First Address | Newbury Park, CA 91320-6444 |
Second Address | Newbury Park, CA 91320 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2015 |
Last Update Date | 01/12/2021 |