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General NPI Number Information
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NPI Number | 1235750811
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Entity Type | Organization
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Legal Business Name | S J SHAHANGIAN DDS MS INC
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Dates
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Enumeration Date | 05/05/2020
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Last Update Date | 10/27/2020
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Provider Practice Location Address
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Address Line | 1620 ALPINE BLVD STE 212
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City | ALPINE
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State | CA
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Zip | 91901-1105
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Country | US
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Telephone | 619-445-8881
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Fax |
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Provider Business Mailing Address
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Address Line | 9840 HIBERT ST STE B4
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City | SAN DIEGO
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State | CA
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Zip | 92131-1071
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Country | US
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Telephone | 858-693-5677
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOSSEIN SHAHANGIAN
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Credential |
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Telephone | 619-445-8881
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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