Provider Demographics
NPI:1215681614
Name:SIAVASH GOLABY SANAJANY DMD INC
Entity type:Organization
Organization Name:SIAVASH GOLABY SANAJANY DMD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SIAVASH
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLABY SANAJANY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:818-922-4057
Mailing Address - Street 1:10921 WILSHIRE BLVD STE 1212
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-4000
Mailing Address - Country:US
Mailing Address - Phone:818-922-4057
Mailing Address - Fax:
Practice Address - Street 1:10921 WILSHIRE BLVD STE 1212
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-4000
Practice Address - Country:US
Practice Address - Phone:818-922-4057
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-05
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty