Provider Demographics
NPI:1881715993
Name:AZIZIAN, SHAHRAM BRIAN
Entity type:Individual
Prefix:MR
First Name:SHAHRAM
Middle Name:BRIAN
Last Name:AZIZIAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13205 OSBORNE
Mailing Address - Street 2:#F
Mailing Address - City:ARLETA
Mailing Address - State:CA
Mailing Address - Zip Code:91331
Mailing Address - Country:US
Mailing Address - Phone:818-890-2426
Mailing Address - Fax:818-890-5402
Practice Address - Street 1:13205 OSBORNE
Practice Address - Street 2:#F
Practice Address - City:ARLETA
Practice Address - State:CA
Practice Address - Zip Code:91331
Practice Address - Country:US
Practice Address - Phone:818-890-2426
Practice Address - Fax:818-890-5402
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB37781122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist