Provider Demographics
NPI:1275906422
Name:BORUKHIM, SHIVA HEDVAT (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHIVA
Middle Name:HEDVAT
Last Name:BORUKHIM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:339 N OAKHURST DR APT 203
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4162
Mailing Address - Country:US
Mailing Address - Phone:310-801-7448
Mailing Address - Fax:
Practice Address - Street 1:339 N OAKHURST DR APT 203
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4162
Practice Address - Country:US
Practice Address - Phone:310-801-7448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-10
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA652381223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry