Provider Demographics
NPI:1780901553
Name:SHAYAN-ZAKARIA, ALI REZA (DMD)
Entity type:Individual
Prefix:DR
First Name:ALI REZA
Middle Name:
Last Name:SHAYAN-ZAKARIA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:ALI
Other - Middle Name:
Other - Last Name:SHAYAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ALI SHAYAN
Mailing Address - Street 1:12415 CLOUDESLY DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-1005
Mailing Address - Country:US
Mailing Address - Phone:858-735-5019
Mailing Address - Fax:
Practice Address - Street 1:11301 WILSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90073-1003
Practice Address - Country:US
Practice Address - Phone:310-478-3711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-03
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA554831223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics