Provider Demographics
NPI:1952652166
Name:SHAYGAN, FARZAD (DDS)
Entity Type:Individual
Prefix:
First Name:FARZAD
Middle Name:
Last Name:SHAYGAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4040 BARRANCA PKWY STE 140
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-4773
Mailing Address - Country:US
Mailing Address - Phone:949-559-7300
Mailing Address - Fax:714-964-2111
Practice Address - Street 1:4040 BARRANCA PKWY STE 140
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-4773
Practice Address - Country:US
Practice Address - Phone:949-559-7300
Practice Address - Fax:949-552-2719
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-27
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA370181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA522394561Medicare PIN