Healthcare Provider Details

I. General information

NPI: 1891131777
Provider Name (Legal Business Name): ALI S.SHAHIDI DDS APDC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2013
Last Update Date: 05/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8524 1/2 ROSECRANS AVE
PARAMOUNT CA
90723-3644
US

IV. Provider business mailing address

8524 1/2 ROSECRANS AVE
PARAMOUNT CA
90723-3644
US

V. Phone/Fax

Practice location:
  • Phone: 562-633-3082
  • Fax: 562-633-3067
Mailing address:
  • Phone: 562-633-3082
  • Fax: 562-633-3067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: MR. ALI S SHAHIDI
Title or Position: PRESIDENT/DENTIST
Credential: DDS
Phone: 562-633-3082