Provider Demographics
NPI:1275714552
Name:SHAYAN, OMID (DDS)
Entity Type:Individual
Prefix:DR
First Name:OMID
Middle Name:
Last Name:SHAYAN
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 1:9922 WALKER ST STE C
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-3097
Mailing Address - Country:US
Mailing Address - Phone:714-220-0354
Mailing Address - Fax:714-220-0427
Practice Address - Street 1:9922 WALKER ST STE C
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:CA
Practice Address - Zip Code:90630-3097
Practice Address - Country:US
Practice Address - Phone:714-220-0354
Practice Address - Fax:714-220-0427
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45408122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist