Healthcare Provider Details

I. General information

NPI: 1730092388
Provider Name (Legal Business Name): SHAWN P. RABIZADEH DDS, PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14526 ROSCOE BLVD
PANORAMA CITY CA
91402-4176
US

IV. Provider business mailing address

1154 E PALMDALE BLVD
PALMDALE CA
93550-4866
US

V. Phone/Fax

Practice location:
  • Phone: 818-893-7858
  • Fax:
Mailing address:
  • Phone: 661-947-2135
  • Fax: 661-947-5419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: SHAWN RABIZADEH
Title or Position: PRESIDENT
Credential: DDS
Phone: 818-370-6466