Healthcare Provider Details

I. General information

NPI: 1710684220
Provider Name (Legal Business Name): GOLSHID SHAKOURI PARTOVI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2023
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13711 FOOTHILL BLVD UNIT A
SYLMAR CA
91342-3137
US

IV. Provider business mailing address

13711 FOOTHILL BLVD UNIT A
SYLMAR CA
91342-3137
US

V. Phone/Fax

Practice location:
  • Phone: 818-755-7390
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number108591
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: