Healthcare Provider Details

I. General information

NPI: 1720217342
Provider Name (Legal Business Name): SHAUN FLYNN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2009
Last Update Date: 11/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8640 W 3RD ST #201
LOS ANGELES CA
90048-3384
US

IV. Provider business mailing address

8640 W 3RD ST #201
LOS ANGELES CA
90048-3384
US

V. Phone/Fax

Practice location:
  • Phone: 818-456-7620
  • Fax:
Mailing address:
  • Phone: 818-456-7620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number58349
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: