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General NPI Number Information
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NPI Number | 1194935684
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Entity Type | Organization
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Legal Business Name | HESAM SHAHOVESIS DMD,INC
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 04/22/2015
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Provider Practice Location Address
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Address Line | 8716 CORD AVE
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City | PICO RIVERA
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State | CA
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Zip | 90660-5507
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Country | US
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Telephone | 714-542-2224
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Fax |
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Provider Business Mailing Address
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Address Line | 8716 CORD AVE
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City | PICO RIVERA
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State | CA
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Zip | 90660-5507
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Country | US
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Telephone | 714-542-2224
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. HESAM SHAHOVEISI
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Credential | DMD
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Telephone | 714-334-4808
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 47798
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License Number State | CA
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