Healthcare Provider Details

I. General information

NPI: 1558254342
Provider Name (Legal Business Name): JUPIN SAMADHI BAGHERZADEH DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2025
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14622 VENTURA BLVD STE 202
SHERMAN OAKS CA
91403-3664
US

IV. Provider business mailing address

20046 VENTURA BLVD
WOODLAND HILLS CA
91364-2637
US

V. Phone/Fax

Practice location:
  • Phone: 818-788-3168
  • Fax:
Mailing address:
  • Phone: 818-297-9476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number111561
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: