Provider Demographics
NPI:1376180331
Name:NOVSHADIAN, SIYOUNEH (DDS)
Entity Type:Individual
Prefix:DR
First Name:SIYOUNEH
Middle Name:
Last Name:NOVSHADIAN
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 1:740 PARNASSUS AVE APT 11
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-2624
Mailing Address - Country:US
Mailing Address - Phone:818-926-2792
Mailing Address - Fax:
Practice Address - Street 1:999 SUTTER ST # 11
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-6023
Practice Address - Country:US
Practice Address - Phone:818-926-2792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-09
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1021771223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5SNU776Medicaid