Provider Demographics
NPI:1114153509
Name:ZARRABI, SHAHROUZ (MD, DDS)
Entity Type:Individual
Prefix:DR
First Name:SHAHROUZ
Middle Name:
Last Name:ZARRABI
Suffix:
Gender:M
Credentials:MD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2865 E COAST HWY STE 300
Mailing Address - Street 2:
Mailing Address - City:CORONA DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92625-2258
Mailing Address - Country:US
Mailing Address - Phone:949-873-0807
Mailing Address - Fax:
Practice Address - Street 1:2865 E COAST HWY STE 300
Practice Address - Street 2:
Practice Address - City:CORONA DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92625-2258
Practice Address - Country:US
Practice Address - Phone:917-327-9969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-31
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
CAA146795204E00000X
CA101197204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No174400000XOther Service ProvidersSpecialist