Healthcare Provider Details

I. General information

NPI: 1104612548
Provider Name (Legal Business Name): ALWAN AND SHAYEFAR DENTAL CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2025
Last Update Date: 04/15/2025
Certification Date: 04/14/2025
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 TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. DANIEL ADAM ALWAN
Title or Position: GENERAL DENTIST
Credential: DDS
Phone: 562-633-3082