Provider Demographics
NPI:1710684220
Name:SHAKOURI PARTOVI, GOLSHID
Entity Type:Individual
Prefix:
First Name:GOLSHID
Middle Name:
Last Name:SHAKOURI PARTOVI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13044 PACIFIC PROMENADE APT 407
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90094-4006
Mailing Address - Country:US
Mailing Address - Phone:310-614-8748
Mailing Address - Fax:
Practice Address - Street 1:18235 SHERMAN WAY
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-4551
Practice Address - Country:US
Practice Address - Phone:818-401-6777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-14
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1085911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty