Basic Information
| Provider Information | |||||||||
| NPI: | 1205021250 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SAHARAN | ||||||||
| FirstName: | SACHIN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 24815 103RD AVE SE | ||||||||
| Address2: | STE. #B103 | ||||||||
| City: | KENT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980305196 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8004174444 | ||||||||
| FaxNumber: | 7145713560 | ||||||||
| Practice Location | |||||||||
| Address1: | 510 W AVENUE P | ||||||||
| Address2: | |||||||||
| City: | PALMDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935513737 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6612739000 | ||||||||
| FaxNumber: | 6612733118 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2007 | ||||||||
| LastUpdateDate: | 09/12/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 56196 | CA | Y | Dental Providers | Dentist |
ID Information
| ID | Type | State | Issuer | Description | D56196 | 05 | CA | MEDICAID |