Provider Demographics
NPI:1366581464
Name:VESHKINI, SIAMAK
Entity type:Individual
Prefix:
First Name:SIAMAK
Middle Name:
Last Name:VESHKINI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 GOLDEN EAGLE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92603-0308
Mailing Address - Country:US
Mailing Address - Phone:949-855-2060
Mailing Address - Fax:949-582-1837
Practice Address - Street 1:26902 OSO PKWY STE 100
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-5801
Practice Address - Country:US
Practice Address - Phone:949-855-2060
Practice Address - Fax:949-582-1837
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA360261223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7032950001Medicare NSC