Provider Demographics
NPI:1023247186
Name:GHAHREMANI, SHIVA (DDS)
Entity type:Individual
Prefix:
First Name:SHIVA
Middle Name:
Last Name:GHAHREMANI
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 1:27789 PALOS VERDES DR E
Mailing Address - Street 2:
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-5148
Mailing Address - Country:US
Mailing Address - Phone:310-488-2616
Mailing Address - Fax:
Practice Address - Street 1:27789 PALOS VERDES DR E
Practice Address - Street 2:
Practice Address - City:RANCHO PALOS VERDES
Practice Address - State:CA
Practice Address - Zip Code:90275-5148
Practice Address - Country:US
Practice Address - Phone:310-488-2616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-10
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA583471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice