Provider Demographics
NPI:1811263734
Name:KHOSHBIN, SARA (DDS)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:KHOSHBIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 VIA TERRACALETA
Mailing Address - Street 2:
Mailing Address - City:COTO DE CAZA
Mailing Address - State:CA
Mailing Address - Zip Code:92679-4016
Mailing Address - Country:US
Mailing Address - Phone:818-486-4573
Mailing Address - Fax:
Practice Address - Street 1:16 VIA TERRACALETA
Practice Address - Street 2:
Practice Address - City:COTO DE CAZA
Practice Address - State:CA
Practice Address - Zip Code:92679-4016
Practice Address - Country:US
Practice Address - Phone:818-486-4573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-25
Last Update Date:2012-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA599341223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry