Provider Demographics
NPI:1649469768
Name:SANJIDEH, PAYAM ATA (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:PAYAM
Middle Name:ATA
Last Name:SANJIDEH
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23487 PARK COLOMBO
Mailing Address - Street 2:
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-2814
Mailing Address - Country:US
Mailing Address - Phone:310-435-7449
Mailing Address - Fax:
Practice Address - Street 1:23487 PARK COLOMBO
Practice Address - Street 2:
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-2814
Practice Address - Country:US
Practice Address - Phone:310-435-7449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-15
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA562011223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics