Individual
DR. SAM S KHORSANDI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S
Contact information
Practice address
16542 VENTURA BLVD, SUITE 506, ENCINO, CA 91436-2005
(818) 981-4867
Mailing address
16542 VENTURA BLVD, SUITE 506, ENCINO, CA 91436-2005
(818) 981-4867
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
36257
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
B3625701
—
CA
Enumeration date
03/08/2007
Last updated
07/09/2007
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