Provider Demographics
NPI:1639230311
Name:RABBANI, SHIMON (DMD)
Entity type:Individual
Prefix:
First Name:SHIMON
Middle Name:
Last Name:RABBANI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14554 NORDHOFF ST
Mailing Address - Street 2:
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-1811
Mailing Address - Country:US
Mailing Address - Phone:818-891-2345
Mailing Address - Fax:818-891-9059
Practice Address - Street 1:14554 NORDHOFF ST
Practice Address - Street 2:
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-1811
Practice Address - Country:US
Practice Address - Phone:818-891-2345
Practice Address - Fax:818-891-9059
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA449921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB44992-02Medicare ID - Type Unspecified