Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Dr. Immanuel Ugonnia Selassie I

Individual provider Dentist · NPI 1053601039

Dr. Immanuel Ugonnia Selassie I is a Dentist in Sacramento, California. Practices as a sole proprietor. Licensed in California.

Licensed in
CA
In the registry since
2011
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Practice location Address checks out

2430 Fair Oaks Blvd (apt 120)
Sacramento, CA 95825-5129
Phone: (206) 384-6915
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dentist (primary) Taxonomy 122300000X · Licence 56829 (CA)

Record details

NPI number1053601039
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedApril 12, 2011
Last updated in NPPESFebruary 28, 2014

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