Provider Demographics
NPI:1063764868
Name:SAHABI, LEYLA
Entity type:Individual
Prefix:DR
First Name:LEYLA
Middle Name:
Last Name:SAHABI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 EL CAMINO REAL APT 4402
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95050-7418
Mailing Address - Country:US
Mailing Address - Phone:818-634-2048
Mailing Address - Fax:
Practice Address - Street 1:6766 BERNAL AVE
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-1218
Practice Address - Country:US
Practice Address - Phone:925-461-3100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-04
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1856143122300000X
CA62728122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist