Provider Demographics
NPI:1699923375
Name:ABAI, SIAMAK (DDS, MMEDSC)
Entity type:Individual
Prefix:
First Name:SIAMAK
Middle Name:
Last Name:ABAI
Suffix:
Gender:M
Credentials:DDS, MMEDSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16300 SAND CANYON AVE STE 506
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3705
Mailing Address - Country:US
Mailing Address - Phone:949-201-4444
Mailing Address - Fax:
Practice Address - Street 1:1431 WARNER AVE STE E
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-6444
Practice Address - Country:US
Practice Address - Phone:949-648-0303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-05
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA549301223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics