Provider Demographics
NPI:1578908380
Name:MEHDIABADI, SHAHNAZ JUM (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHAHNAZ
Middle Name:JUM
Last Name:MEHDIABADI
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 1:10722 SPUR POINT CT
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-4839
Mailing Address - Country:US
Mailing Address - Phone:858-752-3998
Mailing Address - Fax:
Practice Address - Street 1:355 K ST
Practice Address - Street 2:SUITE A
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-1209
Practice Address - Country:US
Practice Address - Phone:619-427-1315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-07
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53133122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist