Healthcare Provider Details

I. General information

NPI: 1467373753
Provider Name (Legal Business Name): SHIRA RAZI DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8525 W PICO BLVD
LOS ANGELES CA
90035-2409
US

IV. Provider business mailing address

PO BOX 351343
LOS ANGELES CA
90035-9743
US

V. Phone/Fax

Practice location:
  • Phone: 626-412-0200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number113475
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: