Provider Demographics
NPI:1942327291
Name:YASSAMY, FARZANEH S
Entity type:Individual
Prefix:DR
First Name:FARZANEH
Middle Name:S
Last Name:YASSAMY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 HUNTINGTON DR
Mailing Address - Street 2:
Mailing Address - City:SAN MARINO
Mailing Address - State:CA
Mailing Address - Zip Code:91108-1824
Mailing Address - Country:US
Mailing Address - Phone:626-441-2231
Mailing Address - Fax:626-441-3024
Practice Address - Street 1:825 HUNTINGTON DR
Practice Address - Street 2:
Practice Address - City:SAN MARINO
Practice Address - State:CA
Practice Address - Zip Code:91108-1824
Practice Address - Country:US
Practice Address - Phone:626-441-2231
Practice Address - Fax:626-441-3024
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47586122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist