Healthcare Provider Details

I. General information

NPI: 1073909115
Provider Name (Legal Business Name): PARISA SHAHI DDS, FACP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2015
Last Update Date: 12/14/2021
Certification Date: 12/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 HICKEY BLVD STE 403
DALY CITY CA
94015-2630
US

IV. Provider business mailing address

1655 THE ALAMEDA
SAN JOSE CA
95126-2203
US

V. Phone/Fax

Practice location:
  • Phone: 650-997-3266
  • Fax: 650-997-3569
Mailing address:
  • Phone: 408-516-4050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number63267
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: