Healthcare Provider Details

I. General information

NPI: 1144959610
Provider Name (Legal Business Name): SHAUNA SHAFAI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2022
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

557 15TH ST
SANTA MONICA CA
90402
US

IV. Provider business mailing address

557 15TH ST
SANTA MONICA CA
90402-2933
US

V. Phone/Fax

Practice location:
  • Phone: 310-666-4590
  • Fax:
Mailing address:
  • Phone: 310-666-4590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number110254
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number110254
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: