Provider Demographics
NPI:1578684346
Name:MALEK, SHAUN (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHAUN
Middle Name:
Last Name:MALEK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:SHAUN
Other - Middle Name:
Other - Last Name:MALEK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:465 N LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-1215
Mailing Address - Country:US
Mailing Address - Phone:626-405-1445
Mailing Address - Fax:626-405-4830
Practice Address - Street 1:465 N LAKE AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-1215
Practice Address - Country:US
Practice Address - Phone:626-405-1445
Practice Address - Fax:626-405-4830
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA365791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice