Provider Demographics
NPI:1437827425
Name:SHAHINYAN, LINA T
Entity Type:Individual
Prefix:DR
First Name:LINA
Middle Name:T
Last Name:SHAHINYAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2828 3RD ST APT 12A
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-4150
Mailing Address - Country:US
Mailing Address - Phone:703-307-8833
Mailing Address - Fax:
Practice Address - Street 1:18520 SOLEDAD CANYON RD STE G
Practice Address - Street 2:
Practice Address - City:CANYON COUNTRY
Practice Address - State:CA
Practice Address - Zip Code:91351-3731
Practice Address - Country:US
Practice Address - Phone:818-793-4499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-02
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106903122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice