Healthcare Provider Details

I. General information

NPI: 1639379142
Provider Name (Legal Business Name): JOSSEIN SHAHANGIAN DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2007
Last Update Date: 04/05/2020
Certification Date: 04/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9840 HIBERT ST STE B4
SAN DIEGO CA
92131-1071
US

IV. Provider business mailing address

9840 HIBERT ST SUITE B-4
SAN DIEGO CA
92131-1071
US

V. Phone/Fax

Practice location:
  • Phone: 858-335-1165
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number150635
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number59342
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number8551
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: