Provider Demographics
NPI:1346780715
Name:SHAYEFAR, JOSHUA BEHNAM (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:BEHNAM
Last Name:SHAYEFAR
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:432 S SAN VICENTE BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-4192
Mailing Address - Country:US
Mailing Address - Phone:310-895-8362
Mailing Address - Fax:
Practice Address - Street 1:420 E 3RD ST STE 1008
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90013-1648
Practice Address - Country:US
Practice Address - Phone:213-625-7141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-03
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT11775122300000X
CA1037571223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentist