Healthcare Provider Details

I. General information

NPI: 1376180331
Provider Name (Legal Business Name): SIYOUNEH NOVSHADIAN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2019
Last Update Date: 12/09/2019
Certification Date: 12/09/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 SUTTER ST # 11
SAN FRANCISCO CA
94109-6023
US

IV. Provider business mailing address

740 PARNASSUS AVE APT 11
SAN FRANCISCO CA
94122-2624
US

V. Phone/Fax

Practice location:
  • Phone: 818-926-2792
  • Fax:
Mailing address:
  • Phone: 818-926-2792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDDS102177
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: