Provider Demographics
NPI:1598069791
Name:KOHANDEL-SHIRAZI, ASAL (DMD)
Entity Type:Individual
Prefix:DR
First Name:ASAL
Middle Name:
Last Name:KOHANDEL-SHIRAZI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 N RAYMOND AVE
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-4610
Mailing Address - Country:US
Mailing Address - Phone:714-870-2000
Mailing Address - Fax:888-801-0908
Practice Address - Street 1:170 N RAYMOND AVE
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-4610
Practice Address - Country:US
Practice Address - Phone:714-870-2000
Practice Address - Fax:888-801-0908
Is Sole Proprietor?:No
Enumeration Date:2011-01-03
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56123122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist