Healthcare Provider Details

I. General information

NPI: 1023731924
Provider Name (Legal Business Name): SHAMSIAN HARIRI DENTAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2022
Last Update Date: 09/26/2022
Certification Date: 09/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8982 WASHINGTON BLVD
PICO RIVERA CA
90660-3765
US

IV. Provider business mailing address

8982 WASHINGTON BLVD
PICO RIVERA CA
90660-3765
US

V. Phone/Fax

Practice location:
  • Phone: 562-222-1551
  • Fax:
Mailing address:
  • Phone: 562-222-1551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. SHAHRIYAR SHAMSIAN
Title or Position: OWNER
Credential: DDS
Phone: 818-674-8487