Provider Demographics
NPI:1326174236
Name:BEHJOU, SHAHRIYAR (DDS, MSC)
Entity Type:Individual
Prefix:DR
First Name:SHAHRIYAR
Middle Name:
Last Name:BEHJOU
Suffix:
Gender:M
Credentials:DDS, MSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:831 S GRETNA GREEN WAY
Mailing Address - Street 2:#101
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-5268
Mailing Address - Country:US
Mailing Address - Phone:310-826-0151
Mailing Address - Fax:626-448-2040
Practice Address - Street 1:10755 LOWER AZUSA RD
Practice Address - Street 2:#B
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-1300
Practice Address - Country:US
Practice Address - Phone:626-448-2040
Practice Address - Fax:626-448-9535
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41352122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA41352OtherCALIFORNIA DENTAL LICENS
CAG-9149701OtherDENTICAL
CAG-9149701OtherDENTICAL