Provider Demographics
NPI:1538279369
Name:AGHASSIBAKE, SHOKOFEH (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHOKOFEH
Middle Name:
Last Name:AGHASSIBAKE
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 1:23415 CRENSHAWBLVD.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505
Mailing Address - Country:US
Mailing Address - Phone:310-791-4100
Mailing Address - Fax:310-791-4097
Practice Address - Street 1:23415 CRENSHAWBLVD.
Practice Address - Street 2:SUITE 200
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505
Practice Address - Country:US
Practice Address - Phone:310-791-4100
Practice Address - Fax:310-791-4097
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA444521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice