Provider Demographics
NPI:1275295412
Name:NIAKI, SHAYAN (DDS)
Entity Type:Individual
Prefix:
First Name:SHAYAN
Middle Name:
Last Name:NIAKI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11420 SANTA MONICA BLVD #252444
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-9998
Mailing Address - Country:US
Mailing Address - Phone:818-305-4660
Mailing Address - Fax:
Practice Address - Street 1:8116 CALIFORNIA AVE STE C
Practice Address - Street 2:
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280-2400
Practice Address - Country:US
Practice Address - Phone:323-567-1821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-05
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1070051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice