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General NPI Number Information
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NPI Number | 1083124093
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Entity Type | Individual
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Provider Name | SHAHIN BAYANI ORTHODONTIST
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Gender | Male
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Dates
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Enumeration Date | 10/04/2017
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Last Update Date | 10/05/2020
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Provider Practice Location Address
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Address Line | 20700 AVALON BLVD STE 600
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City | CARSON
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State | CA
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Zip | 90746-3701
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Country | US
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Telephone | 617-335-8232
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Fax |
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Provider Business Mailing Address
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Address Line | 11740 WILSHIRE BLVD APT A1008
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City | LOS ANGELES
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State | CA
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Zip | 90025-6536
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Country | US
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Telephone | 310-435-6058
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 105572
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License Number State | CA
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