MEDICARE: DR. HENRY HOUSHANG SHADMAN D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	21947	CA

General Provider Information

NPI Number	:	1528155249
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HENRY HOUSHANG SHADMAN D.D.S.

Provider Business Mailing Address
First Line	:	1990 WESTWOOD BLVD SUITE 250
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025
Country	:	US
Telephone Number	:	310-470-5016
Fax Number	:

Provider Business Practice Location Address
First Line	:	1990 WESTWOOD BLVD STE 250
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-8411
Country	:	US
Telephone Number	:	310-470-5016
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	07/08/2007

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