Provider Demographics
NPI:1669576955
Name:SHAHENAZ KAMAL AHMED, DDS, A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:SHAHENAZ KAMAL AHMED, DDS, A PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAHENAZ
Authorized Official - Middle Name:KAMAL
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:562-789-8515
Mailing Address - Street 1:PO BOX 9325
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90608-9325
Mailing Address - Country:US
Mailing Address - Phone:562-789-8515
Mailing Address - Fax:562-789-8505
Practice Address - Street 1:14350 WHITTIER BLVD
Practice Address - Street 2:ST 210
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90605-2103
Practice Address - Country:US
Practice Address - Phone:562-789-8515
Practice Address - Fax:562-789-8505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42512122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB42512-01OtherDENTICEL