Provider Demographics
NPI:1205106242
Name:SHAHRAM HOSSEINI DDS, INC.
Entity type:Organization
Organization Name:SHAHRAM HOSSEINI DDS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:SHAHRAM
Authorized Official - Middle Name:
Authorized Official - Last Name:HOSSEINI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-225-1630
Mailing Address - Street 1:23111 VENTURA BLVD
Mailing Address - Street 2:SUITE #204
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364
Mailing Address - Country:US
Mailing Address - Phone:818-225-1630
Mailing Address - Fax:
Practice Address - Street 1:23111 VENTURA BLVD
Practice Address - Street 2:SUITE #204
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-1103
Practice Address - Country:US
Practice Address - Phone:818-225-1630
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHAHRAM HOSSEINI DDS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-01-09
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53068302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization