Provider Demographics
NPI:1265582894
Name:GHAEMMAGHAMI, SARA (DDS)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:GHAEMMAGHAMI
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 1:3175 S HOOVER ST # 385
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90007-3196
Mailing Address - Country:US
Mailing Address - Phone:818-883-1383
Mailing Address - Fax:
Practice Address - Street 1:3175 S HOOVER ST # 385
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90007-3196
Practice Address - Country:US
Practice Address - Phone:818-883-1383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA361511223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry