Healthcare Provider Details

I. General information

NPI: 1316192305
Provider Name (Legal Business Name): SAHAR SHAFI D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2008
Last Update Date: 07/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10833 LE CONTE AVE CHS 63-048
LOS ANGELES CA
90095-1668
US

IV. Provider business mailing address

10833 LE CONTE AVE CHS 63-048
LOS ANGELES CA
90095-1668
US

V. Phone/Fax

Practice location:
  • Phone: 310-825-3795
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number57400
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: