Healthcare Provider Details

I. General information

NPI: 1376489401
Provider Name (Legal Business Name): WOLFF & SHAMSIAN ORAL & MAXILLOFACIAL SURGERY CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19228 VENTURA BLVD UNIT C
TARZANA CA
91356-3101
US

IV. Provider business mailing address

19228 VENTURA BLVD UNIT C
TARZANA CA
91356-3101
US

V. Phone/Fax

Practice location:
  • Phone: 310-666-4882
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number
License Number State

VIII. Authorized Official

Name: LAWRENCE W
Title or Position: CFO
Credential: DDS
Phone: 818-426-6198