Provider Demographics
NPI:1619643152
Name:SHAHIN SHAMSIAN DDS INC
Entity Type:Organization
Organization Name:SHAHIN SHAMSIAN DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAHIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAMSIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-666-4882
Mailing Address - Street 1:19228 VENTURA BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-3101
Mailing Address - Country:US
Mailing Address - Phone:818-881-1559
Mailing Address - Fax:818-881-3805
Practice Address - Street 1:19228 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-3101
Practice Address - Country:US
Practice Address - Phone:818-881-1559
Practice Address - Fax:818-881-3805
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHAHIN SHAMSIAN DDS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-08-16
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental